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General NPI Number Information
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NPI Number | 1962890731
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Entity Type | Individual
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Provider Name | KAYLA WARD LAT, ATC, CSCS
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Gender | Female
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Dates
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Enumeration Date | 01/02/2015
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Last Update Date | 08/23/2021
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Provider Practice Location Address
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Address Line | 1760 DOWN RIVER DR
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City | WOODLAND
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State | WA
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Zip | 98674-9699
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Country | US
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Telephone | 916-316-5019
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Fax |
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Provider Business Mailing Address
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Address Line | 1760 DOWN RIVER DR
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City | WOODLAND
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State | WA
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Zip | 98674-9699
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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 | AT-AT-10173381
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License Number State | OR
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