| NPI | 1043733348 |
|---|---|
| Former Name | REBECCA LALLEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MI 2601001672) |
| Enumeration Date | 2017-07-19 |
| Last Update Date | 2023-08-31 |