Provider Demographics
NPI:1194125047
Name:DREISBACH, MICHAEL (ATC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:DREISBACH
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6050 ROTHWELL ST RM 132
Mailing Address - Street 2:
Mailing Address - City:FORT SILL
Mailing Address - State:OK
Mailing Address - Zip Code:73503-4482
Mailing Address - Country:US
Mailing Address - Phone:580-442-2131
Mailing Address - Fax:
Practice Address - Street 1:6050 ROTHWELL ST RM 132
Practice Address - Street 2:
Practice Address - City:FORT SILL
Practice Address - State:OK
Practice Address - Zip Code:73503-4482
Practice Address - Country:US
Practice Address - Phone:580-442-2131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-28
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20130066282255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer