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1790565711
KIARA ANN LEBOUTON
APPLETON, WI
NPI
1790565711
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
2255A2300X Specialist/Technologist, Athletic Trainer
(Licence: WI 3121-39)
Enumeration Date
2023-10-05
Last Update Date
2023-10-05
Business Address
KIARA ANN LEBOUTON LAT, ATC
2400 E CAPITOL DR
APPLETON, WI 54911-8728
Phone number: 920-642-1313
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Mailing Address
KIARA ANN LEBOUTON LAT, ATC
996 3RD ST APT 8B
MENASHA, WI 54952-3258
Phone number: 920-642-1313
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