Individual
MRS. DENISE M ELLIS
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
LAT
Contact information
Practice address
415 S PARK LN, SEYMOUR, WI 54165-1411
(920) 833-9120
Mailing address
415 S PARK LN, SEYMOUR, WI 54165-1411
(920) 833-9120
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
104-039
WI
Other
Enumeration date
01/10/2006
Last updated
07/08/2007
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