Individual
KATELYN LLISO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4921 JEAN GRIMES DR APT 106, CHARLOTTE, NC 28269-3049
(704) 557-5874
Mailing address
224 EAST WILSON STREET, WINGATE, NC 28174
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
LAT-3903
NC
Other
Enumeration date
10/01/2021
Last updated
10/01/2021
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