Individual
MS. ANNE MARIE MICINSKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC, LAT
Contact information
Practice address
1005 N HICKORY RD, SOUTH BEND, IN 46615-3723
(574) 233-5754
Mailing address
3718 FERN HILL DR, MISHAWAKA, IN 46544-6265
(574) 257-8512
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36000188A
IN
Other
Enumeration date
12/04/2006
Last updated
07/08/2007
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