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Individual

MS. MARIELA YESENIA RICO JIMENEZ

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
ATC, LAT

Contact information

Practice address
1005 S MAIN ST, FORT SCOTT, KS 66701-2649
(620) 223-0600
Mailing address
849 STATE ST APT 9, FORT SCOTT, KS 66701-2763
(580) 754-0241

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
24-01137
KS

Other

Enumeration date
02/25/2018
Last updated
03/17/2018
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