Individual
MRS. MICHELLE WHITAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAT, PES
Contact information
Practice address
N63W23075 MAIN ST, SUSSEX, WI 53089-5303
(414) 566-4583
(414) 566-4640
Mailing address
711 W MONROVIA AVE, GLENDALE, WI 53217-4432
(414) 566-4583
(414) 566-4640
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
481-039
WI
Other
Enumeration date
07/20/2006
Last updated
07/08/2007
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