Provider Demographics
NPI:1659895050
Name:MILLOVITSCH, ANNE MARIE (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:MARIE
Last Name:MILLOVITSCH
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 JAMES RD
Mailing Address - Street 2:
Mailing Address - City:VOLUNTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06384-2010
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:267 SLATER AVE
Practice Address - Street 2:
Practice Address - City:GRISWOLD
Practice Address - State:CT
Practice Address - Zip Code:06351-2533
Practice Address - Country:US
Practice Address - Phone:860-376-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA25752255A2300X
RI003502255A2300X
CT0002532255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer