Provider Demographics
NPI:1710944657
Name:WILLETS, MICHAEL J (ATC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:WILLETS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2734 COUNTRY SQUIRE DR
Mailing Address - Street 2:
Mailing Address - City:NEW CARLISLE
Mailing Address - State:OH
Mailing Address - Zip Code:45344-9566
Mailing Address - Country:US
Mailing Address - Phone:937-845-1411
Mailing Address - Fax:937-845-9784
Practice Address - Street 1:700 S LIMESTONE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45505-1941
Practice Address - Country:US
Practice Address - Phone:937-328-2027
Practice Address - Fax:937-328-6866
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT 1792255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer