# CASEY WIECK

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1770903288
- **Gender:** Man
- **Credential:** ATC, LMT

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2255A2300X | Athletic Trainer | AT.003604 | OH | Yes |
| 225700000X | Massage Therapist | 33.014715-T-Z | OH | — |

## Other

- **Enumeration date:** 04/23/2014
- **Last updated:** 04/23/2014