Individual
MEGAN WIELOCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
8400 N BECK RD, CANTON, MI 48187-1210
(734) 756-1778
Mailing address
3960 PATIENT CARE DR STE 113, LANSING, MI 48911-4279
(734) 756-1778
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2601002381
MI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2601002381
ATHLETIC TRAINING LICENSE
MI
Enumeration date
04/19/2018
Last updated
12/29/2022
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