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NPI Code Detail

MEDICARE: ABIGAIL FRIESEN ATC, CES

MEDICARE: ABIGAIL FRIESEN ATC, CES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer2016032874MO

General Provider Information

NPI Number : 1689114753
Entity Type Code : Individual
Provider Name (Legal Business Name) : ABIGAIL FRIESEN ATC, CES
Provider Business Mailing Address
First Line : 123 LOG TRAIL DR
Second Line : A
City : BALLWIN
State : MO
Zip : 63011-3764
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1 COLLEGE PARK DR
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63141-8660
Country : US
Telephone Number : 314-485-8415
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/08/2017
Last Update Date : 03/08/2017

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