Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | AT005543 | OH |
Y | 213ES0000X | Sports Medicine | AT005543 | OH |
NPI | 1497305288 |
---|---|
Provider Name | Katelynn Joan Hovlid |
First Address | Wooster, OH 44691-2369 |
Second Address | Wooster, OH 44691-2369 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2019 |
Last Update Date | 13/09/2019 |