Holly Lynn Sisson, MA, AT, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

2601001015 Issued in MI

Practice address

1903 W Michigan Ave
Kalamazoo, MI 49008-5426

Phone

(269) 387-2701

NPI assigned

Apr 16, 2012

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1334534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563235200000",
    "number": "1891052833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1903 W MICHIGAN AVE",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490085426",
            "telephone_number": "269-387-2701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1903 W MICHIGAN AVE",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490085426",
            "telephone_number": "269-387-2701"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Unf Dr",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322247699",
            "country_code": "US",
            "telephone_number": "904-620-2855",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SISSON",
        "first_name": "HOLLY",
        "middle_name": "LYNN",
        "credential": "MA, AT, ATC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-04-16",
        "last_updated": "2019-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MI",
            "license": "2601001015",
            "primary": true
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "FL",
            "license": "AL3101",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mary Brigette Sitarski, LPC
• Jeffrey H Siuda, LBSW
• Mark-Victor Siwoski
• Olivia Maslon Siwoski, M.D.
• Heather Rene Sjoquist, PA, AT, ATC

• Athletic Trainer in Kalamazoo, MI
• Providers in Kalamazoo, MI by specialty
• Athletic Trainer in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2019; 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.