Individual
STACI LYNN BOHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
8585 OH-14, STREETSBORO, OH 44241
(440) 212-1383
Mailing address
638 TAMPICO CT, BEREA, OH 44017-2636
(440) 212-1383
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT.004892
OH
Other
Enumeration date
11/30/2017
Last updated
11/30/2017
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