Individual
SAMANTHA LAINE HIGGERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAT, ATC
Contact information
Practice address
209 S KINGSHIGHWAY ST, SAINT CHARLES, MO 63301-1695
(618) 477-1676
Mailing address
209 S KINGSHIGHWAY ST # 1700, SAINT CHARLES, MO 63301-1695
(618) 477-1676
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
096.005226
IL
2255A2300X
Athletic Trainer
Primary
2020031143
MO
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
09/04/2019
Last updated
06/29/2021
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