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1215439856
KATIE WALLIS
CAPE GIRARDEAU, MO
NPI
1215439856
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Former Name
KATIE NILES
Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
2255A2300X Specialist/Technologist, Athletic Trainer
(Licence: MO 2009024419)
Enumeration Date
2018-02-28
Last Update Date
2018-02-28
Business Address
KATIE WALLIS MS, ATC
1701 LACEY ST
CAPE GIRARDEAU, MO 63701-5230
Phone number: 573-334-4822
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Mailing Address
KATIE WALLIS MS, ATC
141 SOAKIE CRK
CAPE GIRARDEAU, MO 63701-8135
Phone number: 573-275-3307
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