MEDICARE: MRS. JILL MAUREEN BOLLING ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	2006017384	MO

General Provider Information

NPI Number	:	1013170398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JILL MAUREEN BOLLING ATC

Provider Business Mailing Address
First Line	:	6405 METCALF AVE
Second Line	:	STE 220
City	:	OVERLAND PARK
State	:	KS
Zip	:	66202-3927
Country	:	US
Telephone Number	:	816-877-0561
Fax Number	:	816-877-0565

Provider Business Practice Location Address
First Line	:	6405 METCALF AVE
Second Line	:	STE 220
City	:	OVERLAND PARK
State	:	KS
Zip	:	66202-3927
Country	:	US
Telephone Number	:	816-877-0561
Fax Number	:	816-877-0565

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2008
Last Update Date	:	07/07/2008

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