Individual
KATHRYN WADDELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
110 DEER XING, VONORE, TN 37885-2133
(423) 884-6958
Mailing address
PO BOX 767, SUMMERSVILLE, WV 26651-0767
(304) 619-5435
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2924
TN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/11/2018
Last updated
06/28/2022
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