Provider Demographics
NPI:1336709534
Name:CLARKSON UNIVERSITY
Entity Type:Organization
Organization Name:CLARKSON UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT ATHLETIC TRAINER
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:BISHOP
Authorized Official - Suffix:
Authorized Official - Credentials:LAT, ATC
Authorized Official - Phone:315-268-2123
Mailing Address - Street 1:8 CLARKSON AVE # 5830
Mailing Address - Street 2:
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13699-9001
Mailing Address - Country:US
Mailing Address - Phone:315-268-2123
Mailing Address - Fax:315-268-6442
Practice Address - Street 1:8 CLARKSON AVE # 5830
Practice Address - Street 2:
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13699-9001
Practice Address - Country:US
Practice Address - Phone:315-268-2123
Practice Address - Fax:315-268-6442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-19
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty