Individual
MASON T COTTEREL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MAT, ATC
Contact information
Practice address
SOUTHERN ILLINOIS UNIVERSITY EDWARDSVILLE VC 2201, EDWARDSVILLE, IL 62026-3043
(408) 477-0953
(618) 650-5880
Mailing address
6800 WYDOWN BLVD, SAINT LOUIS, MO 63105-3043
(408) 477-0953
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/25/2022
Last updated
11/03/2022
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