MEDICARE: MARISSA KATHRYN UECKER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1174236681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISSA KATHRYN UECKER

Provider Business Mailing Address
First Line	:	6648 OAKLAND AVE APT 1S
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63139-3228
Country	:	US
Telephone Number	:	317-560-0844
Fax Number	:

Provider Business Practice Location Address
First Line	:	2497 CREVE COEUR MILL RD
Second Line	:
City	:	MARYLAND HEIGHTS
State	:	MO
Zip	:	63043-1199
Country	:	US
Telephone Number	:	317-560-0844
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2022
Last Update Date	:	09/02/2024

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