Individual
TAYLOR COLTRIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6032 N TEAL WOOD CIR, PEORIA, IL 61615-2231
(309) 258-7261
Mailing address
6622 N QUEEN FRANCES LN, PEORIA, IL 61615-7844
(309) 258-7261
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2000026392
IL
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
12/08/2015
Last updated
10/05/2017
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