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NPI Code Detail

MEDICARE: KARIN KRZAL A.T.C., L.A.T.

MEDICARE: KARIN KRZAL A.T.C., L.A.T.
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
12255A2300XAthletic TrainerAT322ME

General Provider Information

NPI Number : 1013348275
Entity Type Code : Individual
Provider Name (Legal Business Name) : KARIN KRZAL A.T.C., L.A.T.
Provider Business Mailing Address
First Line : 111 SOUTH ST
Second Line :
City : FARMINGTON
State : ME
Zip : 04938-6823
Country : US
Telephone Number : 207-778-7064
Fax Number : 207-778-8177
Provider Business Practice Location Address
First Line : 163 HIGH ST
Second Line :
City : FARMINGTON
State : ME
Zip : 04938-1942
Country : US
Telephone Number : 207-778-7064
Fax Number : 207-778-8177
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/12/2013
Last Update Date : 12/12/2013

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