| NPI | 1245865302 |
|---|---|
| Former Name | CARITA RACHELLE LOGSDON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: WV AT001452) |
| Enumeration Date | 2020-03-10 |
| Last Update Date | 2020-03-10 |