Individual
MR. KEVIN SHANE ALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
6601 CENTERVILLE BUSINESS PKWY, SUITE 101, CENTERVILLE FINANCE, OH 45459-2691
(937) 208-9356
Mailing address
1863 BRATTLEBORO CT APT D, KETTERING, OH 45440-1739
(937) 291-0529
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
802
OH
Other
Enumeration date
12/30/2006
Last updated
07/08/2007
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