Individual
MS. KATHLEEN M MAYBERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
515 ROANOKE DR, EDWARDSVILLE, IL 62025-2521
(618) 980-5605
Mailing address
515 ROANOKE DR, EDWARDSVILLE, IL 62025-2521
(618) 980-5605
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096.004177
IL
Other
Enumeration date
05/03/2020
Last updated
05/03/2020
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