Individual
MRS. GUSTA MICHELLE OWENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
1411 S CREASY LN, STE 120, LAFAYETTE, IN 47905-7438
(765) 447-4165
Mailing address
1411 S CREASY LN, STE 120, LAFAYETTE, IN 47905-7438
(765) 447-4165
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36001127A
IN
Other
Enumeration date
05/22/2015
Last updated
05/22/2015
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