Organization
OA ASSOCIATED LLC
Active
Other names
Southern Illinois Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
JASON DANIEL NOELDNER ATC,LAT (ATHLETIC TRAINER)
(618) 236-2246
Entity
Organization
Contact information
Practice address
4550 MEMORIAL DR, MOC-1, SUITE G-100, BELLEVILLE, IL 62226-5372
(618) 236-2246
(618) 236-2315
Mailing address
4550 MEMORIAL DR, MOC-1, SUITE G-100, BELLEVILLE, IL 62226-5372
(618) 236-2246
(618) 236-2315
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096002594
IL
Other
Enumeration date
06/22/2011
Last updated
06/22/2011
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