Maisie Boehm, LAT
Individual provider Active NPI Athletic Trainer · Lake Geneva, WI
NPI 1851928329 · NPPES record last updated Mar 25, 2020
Key facts
- NPI
- 1851928329
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- Practice address
- 700 Geneva Pkwy N
Lake Geneva, WI 53147-4594 - Phone
- (262) 249-3529
- Fax
- (262) 249-7955
- NPI assigned
- Mar 25, 2020
- Sex
- Female
- 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
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | Yes |
Addresses
Primary practice location
700 Geneva Pkwy N
Lake Geneva, WI 53147-4594
Mailing address
700 Geneva Pkwy N
Lake Geneva, WI 53147-4594
Phone (262) 249-3529
Other providers in Lake Geneva, WI
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- Ginger Renee Bland
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- Ellen Block
- Andrea D Boeckman
- Ashley E. Boro
- Kenneth B. Bortin
- Susan Lynn Bosman
- Braden Dental Center SC
- Amanda J Braden
All providers in Lake Geneva, WI · Athletic Trainer in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 25, 2020. 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.