Individual
MARY JEANETTE COLLINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC, LATC
Contact information
Practice address
411 CENTRAL METHODIST SQ, FAYETTE, MO 65248-1104
(660) 248-6289
Mailing address
614 S MAIN ST, BROOKFIELD, MO 64628-2341
(660) 734-2083
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2010019646
MO
Other
Enumeration date
12/05/2011
Last updated
12/05/2011
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