Individual
MISS LORRAINE E SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
1313 W MAIN ST, MASCOUTAH, IL 62258-1065
(618) 566-8523
Mailing address
9764 DRUM HILL RD, MASCOUTAH, IL 62258-4528
(217) 473-6963
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096.003851
IL
Other
Enumeration date
05/30/2018
Last updated
05/30/2018
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