Individual
MISS FAWN DEBORAH STATEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, AT
Contact information
Practice address
442 W 4TH AVE, COLUMBUS, OH 43201-3108
(614) 774-3980
Mailing address
442 W 4TH AVE, COLUMBUS, OH 43201-3108
(614) 774-3980
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT - 001826
OH
Other
Enumeration date
05/29/2013
Last updated
05/29/2013
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