MRS. Amanda Dianne Gough, MS, ATC
NPI #1710213178 in Charleston, Illinois
Provider Information
- NPI Number
- 1710213178
- Entity Type
- Individual
- Name
- MRS. Amanda Dianne Gough, MS, ATC
- Gender
- Not Specified
- Sole Proprietor
- No
- Primary Specialty
- Specialist/Technologist - Athletic Trainer
- Credential
- MS, ATC
- Enumeration Date
- Oct 20, 2009
- Last Updated
- Oct 20, 2009
Practice Location
- Address
- 25 W LINCOLN AVE
- City
- Charleston
- State
- Illinois
- ZIP Code
- 61920-3070
- Phone
- (217) 345-9600
Specialties & Taxonomy Codes
| Specialty |
|---|
| Specialist/Technologist - Athletic Trainer — Athletic Trainer |
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