MEDICARE: MR. JAMES W CASTLE 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	AT149	ME
2	2255A2300X	Athletic Trainer	AL 2152	FL

General Provider Information

NPI Number	:	1093708976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES W CASTLE ATC

Provider Business Mailing Address
First Line	:	38 PINECREST CIR
Second Line	:
City	:	NORTH WATERBORO
State	:	ME
Zip	:	04061-4826
Country	:	US
Telephone Number	:	386-214-5147
Fax Number	:

Provider Business Practice Location Address
First Line	:	38 PINECREST CIR
Second Line	:
City	:	NORTH WATERBORO
State	:	ME
Zip	:	04061-4826
Country	:	US
Telephone Number	:	386-214-5147
Fax Number	:

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

Provider Enumeration Date	:	08/25/2005
Last Update Date	:	02/24/2014

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