Individual
KATHERINE LIESENER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
12800 N LAKE SHORE DR, MEQUON, WI 53097-2418
(262) 243-4338
Mailing address
12800 N LAKE SHORE DR, MEQUON, WI 53097-2418
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
681-039
WI
Other
Enumeration date
05/08/2015
Last updated
05/08/2015
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