Mary Colleen Daly, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

256-039 Issued in WI

Practice address

2835 N Grandview Blvd
Siute 100
Pewaukee, WI 53072-5531

Phone

(262) 574-1100

NPI assigned

Jul 20, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1366462319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2606A E PARK PL",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532113840",
            "telephone_number": "414-322-7979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2835 N GRANDVIEW BLVD",
            "address_2": "SIUTE 100",
            "city": "PEWAUKEE",
            "state": "WI",
            "postal_code": "530725531",
            "telephone_number": "262-574-1100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DALY",
        "first_name": "MARY",
        "middle_name": "COLLEEN",
        "name_prefix": "Ms.",
        "credential": "ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "WI",
            "license": "256-039",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Athletic Trainer in Pewaukee, WI
• Providers in Pewaukee, WI by specialty
• Athletic Trainer in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.