Individual
STEFANIE CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2503 WOODLAKE RD SW, APT 4, WYOMING, MI 49519-4710
(330) 347-6272
Mailing address
2503 WOODLAKE RD SW, APT 4, WYOMING, MI 49519-4710
(330) 347-6272
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2601001341
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2601001341
MICHIGAN LICENSE
MI
Enumeration date
06/29/2015
Last updated
06/29/2015
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