Provider Demographics
NPI:1952399719
Name:OBERGOTTSBERGER, MICHAEL F (ATC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:F
Last Name:OBERGOTTSBERGER
Suffix:
Gender:M
Credentials:ATC
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Mailing Address - Street 1:4029 NORTHWEST AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-9077
Mailing Address - Country:US
Mailing Address - Phone:360-734-2277
Mailing Address - Fax:360-734-3006
Practice Address - Street 1:4029 NORTHWEST AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-9077
Practice Address - Country:US
Practice Address - Phone:360-734-2277
Practice Address - Fax:360-734-3006
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WA2255A2300X2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer