Individual
MAGGIE RICHARDSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1230 TOM GINNEVER AVE, O FALLON, MO 63366-4406
(314) 603-0850
Mailing address
3170 HIGHWAY P, WENTZVILLE, MO 63385-2312
(314) 603-0850
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2011040141
MO
Other
Enumeration date
10/07/2014
Last updated
10/07/2014
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