Individual
KACEY CHAMNESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
102 W MONROE ST, ANNA, IL 62906-1607
(618) 201-7951
Mailing address
102 W MONROE ST, ANNA, IL 62906-1607
(618) 201-7951
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096002512
IL
Other
Enumeration date
12/08/2016
Last updated
12/08/2016
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