Individual
BAILEY KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAT
Contact information
Practice address
12800 N LAKE SHORE DR, MEQUON, WI 53097-2418
(262) 243-2147
(262) 243-2969
Mailing address
1737 PATRIOT WAY, MOUNT PLEASANT, WI 53406-2730
(262) 417-6291
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2393-39
WI
Other
Enumeration date
12/21/2020
Last updated
01/15/2021
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