Provider Demographics
NPI:1811417983
Name:SCHLICHTIG, MICHAEL (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:SCHLICHTIG
Suffix:
Gender:M
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:PO BOX 4638
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06813-4638
Mailing Address - Country:US
Mailing Address - Phone:203-648-2413
Mailing Address - Fax:
Practice Address - Street 1:75 SELLECK ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-7207
Practice Address - Country:US
Practice Address - Phone:203-648-2413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-21
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer