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NPI Code Detail

MEDICARE: NATHANIEL DAVID DILLER ATC

MEDICARE: NATHANIEL DAVID DILLER 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
12255A2300XAthletic Trainer

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12000027440OTHERBOC

General Provider Information

NPI Number : 1114442985
Entity Type Code : Individual
Provider Name (Legal Business Name) : NATHANIEL DAVID DILLER ATC
Provider Business Mailing Address
First Line : 209 E ADAMS AVE
Second Line :
City : STERLING
State : KS
Zip : 67579-1914
Country : US
Telephone Number : 567-242-8912
Fax Number :
Provider Business Practice Location Address
First Line : 125 W COOPER ST
Second Line :
City : STERLING
State : KS
Zip : 67579-1533
Country : US
Telephone Number : 567-242-8912
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2017
Last Update Date : 08/13/2017

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