Individual
MRS. AMANDA ANN FULWIDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, AT, ATC
Contact information
Practice address
120 COLEMANS XING, MARYSVILLE, OH 43040-7115
(937) 578-7847
(937) 578-7891
Mailing address
11596 LAFAYETTE PLAIN CITY RD, PLAIN CITY, OH 43064-9010
(937) 243-9742
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
2000030605
—
2255A2300X
Athletic Trainer
Primary
AT006116
OH
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AT006116
ATHLETIC TRAINER
OH
Enumeration date
09/01/2015
Last updated
03/29/2022
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