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NPI Code Detail

MEDICARE: ERICA ENGELHAUPT

MEDICARE: ERICA ENGELHAUPT
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 Trainer24-00951KS
22255A2300XAthletic TrainerMO

General Provider Information

NPI Number : 1336503788
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERICA ENGELHAUPT
Provider Business Mailing Address
First Line : 1108 N 24TH ST
Second Line :
City : SAINT JOSEPH
State : MO
Zip : 64506-2721
Country : US
Telephone Number : 785-259-2363
Fax Number :
Provider Business Practice Location Address
First Line : 4525 DOWNS DR
Second Line :
City : SAINT JOSEPH
State : MO
Zip : 64507-2246
Country : US
Telephone Number : 785-259-2363
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/12/2016
Last Update Date : 08/09/2021

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