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Individual

MS. VICTORIA L GRAHAM

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
ATC

Contact information

Practice address
WESLEYAN UNIVERSITY, 161 CROSS STREET, MIDDLETOWN, CT 06459-0001
(860) 685-3980
Mailing address
25 MCKENZIE ST, 2ND FLOOR, MIDDLETOWN, CT 06457-4620
(860) 398-1704

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
#000052
STATE LICENSE
CT
01
000090279
BOC NUMBER
Enumeration date
01/03/2006
Last updated
04/19/2011
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