Individual
KELLEY LACEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MAT, LAT, ATC
Contact information
Practice address
2201 W UNIVERSITY AVE, MUNCIE, IN 47306-2943
(765) 625-0244
Mailing address
9301 W WINDSOR RD, FARMLAND, IN 47340-9445
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
360002786A
IN
Other
Enumeration date
09/11/2018
Last updated
07/10/2024
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