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General NPI Number Information
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NPI Number | 1417885377
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Entity Type | Individual
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Provider Name | MARY-KATHERINE JUSTINA SCHNACKER MAT, LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 05/11/2026
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Last Update Date | 05/11/2026
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Provider Practice Location Address
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Address Line | 2300 HIGHLAND RD
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City | BATESVILLE
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State | AR
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Zip | 72501-3699
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Country | US
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Telephone | 870-307-7053
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Fax |
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Provider Business Mailing Address
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Address Line | 4 CHAMBLEE CIR
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City | SOUTHSIDE
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State | AR
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Zip | 72501-8000
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Country | US
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Telephone | 940-704-6546
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT1113
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License Number State | AR
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