Individual
KAILEN BERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
5050 AVE MARIA BLVD, AVE MARIA, FL 34142-9505
(239) 304-7865
Mailing address
28190 CREST PRESERVE CIR UNIT 6109, BONITA SPRINGS, FL 34135-6765
(260) 908-4486
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
09/12/2017
Last updated
10/04/2023
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