Kayla Williams

 
 2020 March 20 19:59:15 EDT 
 To: 19537226837 
 Page: 05/637 
 From: Lauris Rigdon 
 Fax: 3374937237 
 Signatures 
 Treating Provider Signature 
 Initiated by Maria Stalder, PT, DPT on 2015 March 08 14:56 EDT. License #: 049147 
 Electronically co-signed by Mary Smith, PT on 2017 July 23 16:01 EDT. License #: 024378 
 Patient Shauna Becker (DOB: 1999 May 29) 
 Treated by Maria Stalder, PT, DPT (License #379137) 
 DOS: 2024 March 06
 Page 4 of 37 of Plan of Care
