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General NPI Number Information
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NPI Number | 1780105486
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Entity Type | Individual
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Provider Name | KATELYN MARIE STAELGRAEVE
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Gender | Female
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Dates
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Enumeration Date | 07/03/2017
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Last Update Date | 07/03/2017
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Provider Practice Location Address
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Address Line | 100 VAN BUREN ST W
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City | BATTLE CREEK
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State | MI
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Zip | 49017-3050
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Country | US
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Telephone | 269-213-3500
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Fax |
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Provider Business Mailing Address
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Address Line | 4791 N ROGERS HWY
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City | BRITTON
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State | MI
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Zip | 49229-8704
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Country | US
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Telephone | 517-759-2477
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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 | 2601001493
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License Number State | MI
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