Healthcare Provider Details

I. General information

NPI: 1841794351
Provider Name (Legal Business Name): AMBER MARIE MCKEE ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 03/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

931 W PHILADELPHIA ST
ONTARIO CA
91762-6218
US

IV. Provider business mailing address

931 W PHILADELPHIA ST
ONTARIO CA
91762-6218
US

V. Phone/Fax

Practice location:
  • Phone: 909-573-7474
  • Fax:
Mailing address:
  • Phone: 909-573-7474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: