Individual
MISS MAKAYLA LEANN WASSENBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
400 S JEFFERSON ST, HILLSBORO, KS 67063-1753
(795) 643-9073
Mailing address
1212 N WALNUT ST, ABILENE, KS 67410-2012
(785) 643-9073
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2000033271
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000033271
BOC CERTIFIED ATHLETIC TRAINER
KS
Enumeration date
07/03/2018
Last updated
07/03/2018
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