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NPI 1104957067

NPI 1104957067 : SONIA ELAINE WEHRLIN ATC, LAT, CSCS : RAVENNA, OH

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General NPI Number Information
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    NPI Number           |    1104957067
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    Entity Type          |    Individual 
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    Provider Name        |    SONIA ELAINE WEHRLIN ATC, LAT, CSCS
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    Gender               |    Female 
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Dates
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    Enumeration Date     |    03/09/2007
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    Last Update Date     |    07/08/2007
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Provider Practice Location Address
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    Address Line         |    6847 N CHESTNUT ST 
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    City                 |    RAVENNA
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    State                |    OH
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    Zip                  |    44266-3929
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    Country              |    US
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    Telephone            |    330-297-2771
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    Fax                  |    
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Provider Business Mailing Address
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    Address Line         |    12900 DUQUETTE AVE NE 
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    City                 |    HARTVILLE
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    State                |    OH
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    Zip                  |    44632
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    Country              |    US
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    Telephone            |    330-877-0412
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    Fax                  |    
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Authorized Official
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    Title or Position    |    
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    Name                 |        
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    Credential           |    
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    Telephone            |    
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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    Taxonomy Code        |    2255A2300X
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    Taxonomy Name        |    Athletic Trainer
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    License Number       |    980210
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    License Number State |    OH
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