Basic Information
| Provider Information | |||||||||
| NPI: | 1083070528 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEWITT | ||||||||
| FirstName: | AIMEE | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | B.S., LAT, ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 515 ARBOR RIDGE LN | ||||||||
| Address2: | |||||||||
| City: | TITUSVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327801904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3217045409 | ||||||||
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| Practice Location | |||||||||
| Address1: | 121 N 20TH ST | ||||||||
| Address2: | |||||||||
| City: | OPELIKA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 368015449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3347498303 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2016 | ||||||||
| LastUpdateDate: | 01/13/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | 1684 | AL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.