Provider Demographics
NPI:1326553488
Name:MCKEE, MARY RUTH (MAED, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:RUTH
Last Name:MCKEE
Suffix:
Gender:F
Credentials:MAED, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 WESTMINSTER AVE
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MO
Mailing Address - Zip Code:65251-1230
Mailing Address - Country:US
Mailing Address - Phone:573-592-5861
Mailing Address - Fax:
Practice Address - Street 1:501 WESTMINSTER AVE
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MO
Practice Address - Zip Code:65251-1230
Practice Address - Country:US
Practice Address - Phone:573-592-5861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-11
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20170304982255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer