Individual
MRS. SUSAN KAY LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
A.T.C.
Contact information
Practice address
621 SCIENCE DR, MADISON, WI 53711-1074
(608) 262-1292
Mailing address
N1627 POEPPEL RD, FORT ATKINSON, WI 53538-9329
(920) 563-0914
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
17-039
WI
Other
Enumeration date
06/27/2006
Last updated
03/30/2014
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