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Ohio Occupational Therapy, Physical Therapy, and Athletic Trainers Board 77 South High Street, 16th Floor Columbus, Ohio 432156108Governor Mike DeWine Executive Director Missy AnthonySupervising Physician Contact Information Completed forms should be maintained in the records of the athletic trainer and each collaborating physician; they do not need to be filed with the OTPTAT Board.Supervising Physician Contact Information Supervising Physician Name (Last, First, Middle): Supervising Physician

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