Individual
AMANDA MARIE BOUCHEY I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
901 S NATIONAL AVE, SPRINGFIELD, MO 65897-0001
(417) 836-5000
Mailing address
1005 HAMPTON DR, CENTRALIA, MO 65240-1081
(309) 265-8167
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2019017599
MO
Other
Enumeration date
06/10/2019
Last updated
06/10/2019
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