Individual
KIMBERLY MELLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
17128 W CUNNINGHAM CT, LIBERTYVILLE, IL 60048-9469
(847) 650-0286
Mailing address
1 UNIVERSITY AVE, BOURBONNAIS, IL 60914-2345
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096.004035
IL
Other
Enumeration date
11/16/2015
Last updated
11/16/2015
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