Provider Demographics
NPI:1861603987
Name:MILLWARD, MICHAEL J (ATC, LAT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:J
Last Name:MILLWARD
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1771 CRANBERRY CT
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44905-2303
Mailing Address - Country:US
Mailing Address - Phone:419-342-5065
Mailing Address - Fax:
Practice Address - Street 1:20 MORRIS RD
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:OH
Practice Address - Zip Code:44875-1152
Practice Address - Country:US
Practice Address - Phone:419-342-1724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT.0027602255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer