Individual
LAURA LEE FAFARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
11134 N STATE ROAD 77, HAYWARD, WI 54843-5325
(715) 634-5505
(715) 634-5558
Mailing address
16223 W EASY ST, HAYWARD, WI 54843-2586
(715) 634-2257
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
396-039
WI
Other
Enumeration date
11/16/2006
Last updated
07/08/2007
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