Individual
HAYLEY WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2725 JACKSON ST, OSHKOSH, WI 54901-1513
(920) 223-7743
Mailing address
2725 JACKSON ST, OSHKOSH, WI 54901-1513
(920) 223-7743
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
889
WI
Other
Enumeration date
11/20/2007
Last updated
11/20/2007
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