MEDICARE: MRS. CHRISTINA FARLEY ATC/L

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	038	FL

General Provider Information

NPI Number	:	1023047024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHRISTINA FARLEY ATC/L

Provider Business Mailing Address
First Line	:	20300 RALSTON ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32833-4922
Country	:	US
Telephone Number	:	407-568-3309
Fax Number	:

Provider Business Practice Location Address
First Line	:	11501 EASTWOOD DRIVE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32833-4922
Country	:	US
Telephone Number	:	321-239-9204
Fax Number	:

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

Provider Enumeration Date	:	07/02/2006
Last Update Date	:	07/08/2007

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