Healthcare Provider Details

I. General information

NPI: 1316911167
Provider Name (Legal Business Name): KERRY E WAPLE ATC, CSCS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

479 PARSONS AVE
COLUMBUS OH
43215-5577
US

IV. Provider business mailing address

9336 SPRINGDALE DR
POWELL OH
43065-9629
US

V. Phone/Fax

Practice location:
  • Phone: 614-722-5577
  • Fax:
Mailing address:
  • Phone: 614-832-3219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT790
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: