Individual
MR. TYLER MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA, ATC, LAT
Contact information
Practice address
900 WOOD RD, KENOSHA, WI 53144-1133
(262) 595-2164
(262) 595-2225
Mailing address
1296 VILLAGE CENTRE DR, UNIT 5, KENOSHA, WI 53144-7265
(262) 515-1035
(262) 595-2225
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1310-39
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1310-39
DEPARTMENT OF SAFETY AND PROFESSIONAL SERVICES
WI
01
—
2000003066
NATABOC
WI
Enumeration date
01/30/2015
Last updated
01/30/2015
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