Mary Colleen Daly, ATC
Individual provider Active NPI Athletic Trainer · Pewaukee, WI
NPI 1366462319 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1366462319
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- License
- 256-039 (WI)
- Practice address
- 2835 N Grandview Blvd
Siute 100
Pewaukee, WI 53072-5531 - Phone
- (262) 574-1100
- NPI assigned
- Jul 20, 2006
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 256-039 | WI | MD | Athletic Trainer |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 256-039 | WI | Yes |
Addresses
Primary practice location
2835 N Grandview Blvd
Siute 100
Pewaukee, WI 53072-5531
Mailing address
2606A E Park PL
Milwaukee, WI 53211-3840
Phone (414) 322-7979
Other providers in Pewaukee, WI
- Costco Wholesale Corporation
- Judith Marie Crabb
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- Kirsten Cull
- Frederick Dalangin
- Derek Scott Damrow
- Natalie Daniel
- William Alexander Davies
- Katelyn Ann Dawson
- DCP of Delafield (Milwaukee), LLC
All providers in Pewaukee, WI · Athletic Trainer in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.