Individual
OLIVIA MARQUARDT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3946 ICE WAY, FORT WAYNE, IN 46808
(530) 363-3181
Mailing address
3946 ICE WAY, FORT WAYNE, IN 46808
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2000030355
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000030355
CERTIFIED ATHLETIC TRAINER
IN
Enumeration date
11/16/2018
Last updated
11/16/2018
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