Ethan Burk
Individual provider Active NPI Athletic Trainer · Orono, ME
NPI 1316616535 · NPPES record last updated Jan 21, 2025
Key facts
- NPI
- 1316616535
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- License
- AT962 (ME)
- Practice address
- Bennett, 18 Gym Dr
Orono, ME 04473 - Phone
- (207) 450-4095
- NPI assigned
- Sep 10, 2021
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AT962 | ME | MD | Athletic Trainer |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Athletic Trainer | 2255A2300X | |||
| Athletic Trainer | 2255A2300X | AT962 | ME | Yes |
Addresses
Primary practice location
Bennett, 18 Gym Dr
Orono, ME 04473
Mailing address
18 Bower St
Bangor, ME 04401-4722
Phone (207) 450-4095
Other providers in Orono, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 21, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.