| NPI | 1235649138 |
|---|---|
| Former Name | KEEGAN SHEA WICKMAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MT ATR-LAT-LIC-1881) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer |
| Enumeration Date | 2017-10-05 |
| Last Update Date | 2020-06-02 |