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General NPI Number Information
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NPI Number | 1720465149
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Entity Type | Individual
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Provider Name | BAILEY L WEHRLE AT
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Gender | Female
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Dates
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Enumeration Date | 05/05/2015
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Last Update Date | 05/07/2018
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Provider Practice Location Address
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Address Line | N2930 STATE ROAD 22
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City | WAUTOMA
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State | WI
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Zip | 54982-5267
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Country | US
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Telephone | 920-361-1313
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Fax |
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Provider Business Mailing Address
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Address Line | E2638 MARION LN
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City | WAUPACA
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State | WI
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Zip | 54981-8424
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Country | US
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Telephone |
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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 | L200-0729-3909-08
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 1864
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License Number State | WI
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