Individual
MISS MICHAELA ELIZABETH DESANTIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
600 LINCOLN AVE, CHARLESTON, IL 61920-3011
(217) 581-3811
Mailing address
600 LINCOLN AVE, CHARLESTON, IL 61920-3011
(217) 581-3811
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096004270
IL
Other
Enumeration date
05/11/2017
Last updated
05/11/2017
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