Provider Demographics
NPI:1912182015
Name:LAINGEN, MARY CAMILLE (ATC)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:CAMILLE
Last Name:LAINGEN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:CAMILLE
Other - Last Name:EATON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:168 E LONGVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1236
Mailing Address - Country:US
Mailing Address - Phone:419-778-9018
Mailing Address - Fax:
Practice Address - Street 1:535 IRVING SCHOTTENSTEIN DR
Practice Address - Street 2:WOODY HAYES ATHLETIC CENTER
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1044
Practice Address - Country:US
Practice Address - Phone:614-292-1165
Practice Address - Fax:614-292-3258
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT-27102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer