Individual
ELLEN MAE BLANCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2450 BENDING WILLOW DR, KETTERING, OH 45440-1108
(937) 751-5380
Mailing address
2450 BENDING WILLOW DR, KETTERING, OH 45440-1108
(937) 751-5380
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
OH
390200000X
Student in an Organized Health Care Education/Training Program
—
OH
Other
Enumeration date
08/30/2018
Last updated
08/30/2018
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