Individual
EMILY LEGAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAT
Contact information
Practice address
2629 N 7TH ST, SHEBOYGAN, WI 53083-4932
(920) 451-5550
Mailing address
308 GOSCHEY DR, BELGIUM, WI 53004-9686
(262) 422-9066
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2109-39
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2109-39
ATHLETIC TRAINER LICENSE
WI
Enumeration date
06/19/2018
Last updated
06/19/2018
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