Individual
KATHLEEN MAYREE SHADISH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAT, ATC
Contact information
Practice address
3 BISHOP ALY, CECIL, PA 15321
(412) 913-1812
Mailing address
3 BISHOP ALY, CECIL, PA 15321-1199
(412) 913-1812
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
0126002868
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/07/2017
Last updated
06/12/2018
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