Individual
STACY LILLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
113 W ADAIR ST, OWENTON, KY 40359-3020
(606) 875-4706
Mailing address
113 W ADAIR ST, OWENTON, KY 40359-3020
(606) 875-4706
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
KY
Other
Enumeration date
03/02/2017
Last updated
03/02/2017
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