Individual
MISS ERICA LEIGH VANOVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAT, ATC
Contact information
Practice address
727 W RAAB RD APT 11, NORMAL, IL 61761-4145
(614) 288-3612
Mailing address
8441 TIBBERMORE CT, DUBLIN, OH 43017-9721
(614) 288-3612
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096.004955
IL
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
01/10/2017
Last updated
12/26/2020
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