Individual
MR. TYLER REN WICKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1401 PRESQUE ISLE AVE, MARQUETTE, MI 49855-2818
(360) 593-1714
Mailing address
303 MEYLAND HALL, MARQUETTE, MI 49855-5391
(360) 593-1714
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2601001755
MI
Other
Enumeration date
02/15/2018
Last updated
02/15/2018
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