Healthcare Provider Details

I. General information

NPI: 1316766033
Provider Name (Legal Business Name): BAILEIGH MORRIS LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2024
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1432 SOUTHWEST BLVD
JEFFERSON CITY MO
65109-2444
US

IV. Provider business mailing address

2614 BARNHILL RD
JEFFERSON CITY MO
65109-8400
US

V. Phone/Fax

Practice location:
  • Phone: 573-632-5614
  • Fax:
Mailing address:
  • Phone: 573-694-5160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2026025734
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: