Individual
AMANDA BLAIZE COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
2135 S FREEMONT AVE, SPRINGFIELD, MO 65804
(417) 820-2000
Mailing address
2135 S FREEMONT AVE, SPRINGFIELD, MO 65804
(417) 820-2000
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2012017269
MO
Other
Enumeration date
09/07/2012
Last updated
09/07/2012
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