Individual
MR. KRIS GREGORY LAISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
309 MARCELLA LN, CRIDERSVILLE, OH 45806-2218
(419) 645-5156
Mailing address
309 MARCELLA LN, CRIDERSVILLE, OH 45806-2218
(419) 645-5156
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT-1525
OH
Other
Enumeration date
05/30/2013
Last updated
05/30/2013
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