Individual
HEATHER COLLEEN CARROLL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
2937 S BRENTWOOD BLVD, BRENTWOOD, MO 63144-2713
(314) 961-3804
Mailing address
7331 ZEPHYR PL, 2E, MAPLEWOOD, MO 63143-2221
(702) 375-5227
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2008021131
MO
Other
Enumeration date
11/25/2014
Last updated
11/25/2014
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