Provider Demographics
NPI:1447037270
Name:MICKEY, SAVANAH LEE (LAT, ATC)
Entity type:Individual
Prefix:MS
First Name:SAVANAH
Middle Name:LEE
Last Name:MICKEY
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 ADDISON PARK DR NW APT 206
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35806-1878
Mailing Address - Country:US
Mailing Address - Phone:760-519-0352
Mailing Address - Fax:
Practice Address - Street 1:101ST DSB, SPRC BLDG 6871
Practice Address - Street 2:
Practice Address - City:FORT CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:44223
Practice Address - Country:US
Practice Address - Phone:270-412-4853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-14
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL24822255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer