MEDICARE: MISS JAMIE LYNN ADAMS 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	08060402541	OTHER		NATA

General Provider Information

NPI Number	:	1447212311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JAMIE LYNN ADAMS ATC

Provider Business Mailing Address
First Line	:	1531 ALLEGRO CT
Second Line	:
City	:	PASO ROBLES
State	:	CA
Zip	:	93446-1839
Country	:	US
Telephone Number	:	805-610-7467
Fax Number	:

Provider Business Practice Location Address
First Line	:	805 AEROVISTA PL
Second Line	:
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93401-7919
Country	:	US
Telephone Number	:	805-235-1455
Fax Number	:

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

Provider Enumeration Date	:	04/05/2006
Last Update Date	:	01/29/2008

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