Provider Demographics
NPI:1699823799
Name:HUBBARD, ADRIENNE MARIE (ATC)
Entity type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:MARIE
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:ADRIENNE
Other - Middle Name:MARIE
Other - Last Name:CHRISTOPHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ATC
Mailing Address - Street 1:756 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49456-1951
Mailing Address - Country:US
Mailing Address - Phone:616-402-6226
Mailing Address - Fax:
Practice Address - Street 1:756 RIVER STREET
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:MI
Practice Address - Zip Code:49456-1951
Practice Address - Country:US
Practice Address - Phone:616-402-6226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI22OtherRESPIRATORY, REHABILITATI