Individual
MRS. KELLEY POTILA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
255 MAGGILU CT, JEFFERSON, WI 53549-2095
(715) 572-1961
Mailing address
255 MAGGILU CT, JEFFERSON, WI 53549-2095
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1794-39
WI
Other
Enumeration date
04/30/2020
Last updated
04/30/2020
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