Individual
MR. MICHAEL MATTHEW NOVELLINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAT, ATC, CEAS III
Contact information
Practice address
800 FUYAO AVE, MORAINE, OH 45439-7500
(937) 493-5777
Mailing address
2550 STEEPLECHASE DR, MIAMISBURG, OH 45342-5501
(848) 459-7683
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT005847
OH
Other
Enumeration date
05/23/2016
Last updated
05/06/2020
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