Active NPI
Autumn Anderson, AT, ATC
- Athletic Trainer
- Novi, MI
National Provider Identifier
1437721388
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 2601002564
- Practice address
- 21600 Novi Rd
Novi, MI 48375-5605 - Phone
- (248) 679-5396
- NPI assigned
- Jul 12, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 2601002564 | MI | Primary |
Addresses
Primary practice location
21600 Novi Rd
Novi, MI 48375-5605
Mailing address
5678 Drake Hollow Dr W
West Bloomfield, MI 48322-1274
Phone (313) 282-7013
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2601002564 | MI | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1626048000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1626048000000",
"number": "1437721388",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5678 DRAKE HOLLOW DR W",
"city": "WEST BLOOMFIELD",
"state": "MI",
"postal_code": "483221274",
"telephone_number": "313-282-7013"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21600 NOVI RD",
"city": "NOVI",
"state": "MI",
"postal_code": "483755605",
"telephone_number": "248-679-5396"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "AUTUMN",
"credential": "AT, ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-07-12",
"last_updated": "2021-07-12",
"certification_date": "2021-07-12",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "MI",
"license": "2601002564",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Novi, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.