Individual
KATY RENEE GAYFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC, PHD
Contact information
Practice address
701 COLLEGE RD, LEBANON, IL 62254-1291
(618) 537-6472
Mailing address
701 COLLEGE RD, LEBANON, IL 62254-1291
(618) 537-6472
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096001698
IL
Other
Enumeration date
06/18/2020
Last updated
06/18/2020
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