Healthcare Provider Details

I. General information

NPI: 1578552741
Provider Name (Legal Business Name): KIRSTEN L LAMERE ATC,CSCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 03/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3111 GUNDERSEN DR
ONALASKA WI
54650
US

IV. Provider business mailing address

902 REMINGTON DR
HOLMEN WI
54636-8705
US

V. Phone/Fax

Practice location:
  • Phone: 608-775-8600
  • Fax: 608-775-8614
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number180-039
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1276
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: