Provider Demographics
NPI:1700128212
Name:WILLEN, DANIEL (MA, ATC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:WILLEN
Suffix:
Gender:M
Credentials:MA, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PAUL BROWN STADIUM
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45202-3418
Mailing Address - Country:US
Mailing Address - Phone:513-455-8473
Mailing Address - Fax:513-455-8477
Practice Address - Street 1:1 PAUL BROWN STADIUM
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-3418
Practice Address - Country:US
Practice Address - Phone:513-455-8473
Practice Address - Fax:513-455-8477
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-22
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT-16292255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer