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NPI Code Detail

MEDICARE: STEPHANIE ANN KAISER ATC/L

MEDICARE: STEPHANIE ANN KAISER ATC/L
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 Trainer096-00978IL

General Provider Information

NPI Number : 1427026962
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE ANN KAISER ATC/L
Provider Business Mailing Address
First Line : 879 COUNTY ROAD 800 E
Second Line :
City : CHAMPAIGN
State : IL
Zip : 61822-9736
Country : US
Telephone Number : 217-383-4237
Fax Number :
Provider Business Practice Location Address
First Line : 810 W ANTHONY DR
Second Line :
City : URBANA
State : IL
Zip : 61802-7431
Country : US
Telephone Number : 217-383-4237
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/10/2006
Last Update Date : 07/08/2007

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