Provider Demographics
NPI:1891907465
Name:STAFFORD, MICHELLE RENEE (ATC)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:RENEE
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9988 W UNION RD
Mailing Address - Street 2:
Mailing Address - City:MEDWAY
Mailing Address - State:OH
Mailing Address - Zip Code:45341-9747
Mailing Address - Country:US
Mailing Address - Phone:937-849-1135
Mailing Address - Fax:
Practice Address - Street 1:9988 W UNION RD
Practice Address - Street 2:
Practice Address - City:MEDWAY
Practice Address - State:OH
Practice Address - Zip Code:45341-9747
Practice Address - Country:US
Practice Address - Phone:937-849-1135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT0021092255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer