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General NPI Number Information
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NPI Number | 1336296821
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Entity Type | Individual
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Provider Name | HOLLY LYNN KASAVANA ATC
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Gender | Female
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 131 DUFFY DAUGHERTY BLDG MICHIGAN STATE UNIVERSITY
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City | EAST LANSING
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State | MI
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Zip | 48824
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Country | US
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Telephone | 517-353-4369
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Fax |
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Provider Business Mailing Address
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Address Line | 5123 BARTON RD
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City | WILLIAMSTON
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State | MI
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Zip | 48895-9304
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Country | US
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Telephone | 517-655-4663
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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 |
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License Number State |
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