Individual
KELLY WIEREMA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A, A.T.C
Contact information
Practice address
162 W LEMON AVE UNIT B, MONROVIA, CA 91016-2810
(408) 230-2092
Mailing address
162 W LEMON AVE UNIT B, MONROVIA, CA 91016-2810
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
06/28/2017
Last updated
06/28/2017
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