MEDICARE: JEROMY ALT

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	AT 002719	OH

General Provider Information

NPI Number	:	1316357445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEROMY ALT

Provider Business Mailing Address
First Line	:	271 FRENCH HL E
Second Line	:	3202 EDEN AVENUE
City	:	CINCINNATI
State	:	OH
Zip	:	45267-0394
Country	:	US
Telephone Number	:	513-558-3725
Fax Number	:

Provider Business Practice Location Address
First Line	:	271 FRENCH HL E
Second Line	:	3202 EDEN AVENUE
City	:	CINCINNATI
State	:	OH
Zip	:	45267-0394
Country	:	US
Telephone Number	:	513-558-3725
Fax Number	:

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

Provider Enumeration Date	:	04/29/2014
Last Update Date	:	08/02/2016

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Directions to “ JEROMY ALT ” Practice Location

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