MEDICARE: APRIL LYNNE TERRY 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	970687	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	970687	OTHER		ATHLETIC TRAINER

General Provider Information

NPI Number	:	1376612705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	APRIL LYNNE TERRY ATC

Provider Business Mailing Address
First Line	:	PO BOX 1085
Second Line	:
City	:	MARION
State	:	MT
Zip	:	59925-1085
Country	:	US
Telephone Number	:	406-212-2322
Fax Number	:

Provider Business Practice Location Address
First Line	:	644 SIXTH AVENUE WEST
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59901-1085
Country	:	US
Telephone Number	:	406-212-2322
Fax Number	:

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

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	07/08/2007

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