Sally Susan Egan, ATC, LAT, CSCS

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

Practice address

100 Cty Rd B
Therapy Services
Shawano, WI 54166-7072

Phone

(715) 526-2111

NPI assigned

Feb 15, 2007

Last updated

Oct 4, 2015By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Ms. Sally Susan Buckett Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1443916800000",
    "number": "1609919182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W12529 ZIMDARS RD",
            "city": "LEOPOLIS",
            "state": "WI",
            "postal_code": "549489732",
            "telephone_number": "715-853-3565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 CTY RD B",
            "address_2": "THERAPY SERVICES",
            "city": "SHAWANO",
            "state": "WI",
            "postal_code": "541667072",
            "telephone_number": "715-526-2111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EGAN",
        "first_name": "SALLY",
        "middle_name": "SUSAN",
        "name_prefix": "Mrs.",
        "credential": "ATC, LAT, CSCS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-15",
        "last_updated": "2015-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SALLY",
            "last_name": "BUCKETT",
            "middle_name": "SUSAN",
            "prefix": "MS.",
            "credential": "ATC, LAT, CSCS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Athletic Trainer in Shawano, WI
• Providers in Shawano, WI by specialty
• Athletic Trainer in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.