Individual
KELLEN GATZEMEYER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2116 PROVIDENCE PARK LN, HERCULANEUM, MO 63048-1714
(573) 535-0144
Mailing address
2116 PROVIDENCE PARK LN, HERCULANEUM, MO 63048-1714
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2014008745
MO
Other
Enumeration date
11/24/2014
Last updated
11/24/2014
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