Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 0016740 | CO |
Y | 213ES0000X | Sports Medicine | 0016740 | CO |
NPI | 1285220996 |
---|---|
Provider Name | Alicia Woller |
First Address | Steamboat Springs, CO 80477-6056 |
Second Address | Steamboat Springs, CO 80487-8048 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2020 |
Last Update Date | 16/12/2020 |