NPI 1003170622

Angelina M Wills, ATC

Practitioner Specialist Saint Louis, MO

Practice location

Address: 3330 Laclede Ave Chaifetz Arena, Saint Louis, MO 63103-2014
Phone: (314) 977-7018
Fax: (314) 977-3183

Registered specialties

Specialist Primary

Other Service Providers Taxonomy 174400000X Licence 2005005317 (MO)

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Registry record

NPI: 1003170622
Entity type: Individual
Sex (as registered): Male
NPI issued: 28 Jun 2012
Record last updated: 28 Jun 2012

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.