| NPI | 1528603792 |
|---|---|
| Former Name | STEFANIE REILLY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: WA 2000002436) |
| Enumeration Date | 2019-11-12 |
| Last Update Date | 2019-11-12 |