Individual
THOMAS DETTLAFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1886 LITTLE VALLEY CT, DE PERE, WI 54115-7901
(920) 606-3489
Mailing address
1886 LITTLE VALLEY CT, DE PERE, WI 54115-7901
(920) 606-3489
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
09/14/2015
Last updated
09/14/2015
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