MEDICARE: KAREN P BALTER 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	000304	NY

General Provider Information

NPI Number	:	1184777450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN P BALTER ATC

Provider Business Mailing Address
First Line	:	26 AUTUMN LN
Second Line	:
City	:	WEST SAND LAKE
State	:	NY
Zip	:	12196-2400
Country	:	US
Telephone Number	:	518-674-0421
Fax Number	:

Provider Business Practice Location Address
First Line	:	26 AUTUMN LN
Second Line	:
City	:	WEST SAND LAKE
State	:	NY
Zip	:	12196-2400
Country	:	US
Telephone Number	:	518-674-0421
Fax Number	:

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

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	07/08/2007

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