Individual
KATELYN LUSSOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2801 W BANCROFT ST, TOLEDO, OH 43606-3328
(812) 584-9858
Mailing address
24817 TREE TOP DR, SUNMAN, IN 47041-7433
(812) 584-9858
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
10/13/2015
Last updated
05/10/2018
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