Individual
MISS MADISON ELIZABETH BLAUVELT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
350 MIDWAY DR, KENT, OH 44242-0001
(734) 652-5824
Mailing address
1839 ASHTON LN APT 177, KENT, OH 44240-8132
(734) 652-5824
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
2601002190
MI
2255A2300X
Athletic Trainer
Primary
AT006391
OH
Other
Enumeration date
04/07/2022
Last updated
04/07/2022
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