Individual
MS. STACEY KISIL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC, CAT(C), CSCS
Contact information
Practice address
100 SMITH ST, ATHENS, GA 30602-1505
(706) 296-2765
Mailing address
1188 GARDEN ROAD, MISSISSAUGA, ONTARIO L5H 3-J6
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AHY-881471003
GA
Other
Enumeration date
08/06/2019
Last updated
08/06/2019
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