Healthcare Provider Details

I. General information

NPI: 1770085201
Provider Name (Legal Business Name): DANIEL KEVIN FOHEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2018
Last Update Date: 02/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 COLLEGE HL
CANTON MO
63435-1257
US

IV. Provider business mailing address

3101 ST. MARY'S AVENUE
HANNIBAL MO
63401
US

V. Phone/Fax

Practice location:
  • Phone: 573-288-6000
  • Fax:
Mailing address:
  • Phone: 573-822-2995
  • 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: