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General NPI Number Information
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NPI Number | 1508582214
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Entity Type | Individual
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Provider Name | SAMANTHA LARKIN ATC
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Gender | Female
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Dates
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Enumeration Date | 10/13/2022
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Last Update Date | 10/13/2022
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Provider Practice Location Address
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Address Line | 4200 RUSTY RD
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City | SAINT LOUIS
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State | MO
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Zip | 63128-1973
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Country | US
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Telephone | 314-894-7950
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Fax |
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Provider Business Mailing Address
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Address Line | 3158 WELLINGTON WAY
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City | ARNOLD
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State | MO
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Zip | 63010-3724
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Country | US
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Telephone | 314-732-7266
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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 | 2022039993
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License Number State | MO
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