Individual
KAYLA DEWOLF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC, LAT
Contact information
Practice address
1471 W ALLEN ST, BLOOMINGTON, IN 47403
(503) 477-2828
Mailing address
1471 W ALLEN ST, BLOOMINGTON, IN 47403
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36002468A
IN
Other
Enumeration date
11/30/2015
Last updated
11/30/2015
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