Individual
KATIE WALLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, ATC
Contact information
Practice address
1701 LACEY ST, CAPE GIRARDEAU, MO 63701-5230
(573) 334-4822
Mailing address
141 SOAKIE CRK, CAPE GIRARDEAU, MO 63701-8135
(573) 275-3307
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2009024419
MO
Other
Enumeration date
02/28/2018
Last updated
02/28/2018
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