MEDICARE: KATHERINE JOY BELLO MED, 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	293	NH

General Provider Information

NPI Number	:	1477630614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE JOY BELLO MED, ATC

Provider Business Mailing Address
First Line	:	PO BOX 112
Second Line	:
City	:	MERIDEN
State	:	NH
Zip	:	03770-0112
Country	:	US
Telephone Number	:	603-236-2282
Fax Number	:

Provider Business Practice Location Address
First Line	:	54 MAIN ST
Second Line	:
City	:	MERIDEN
State	:	NH
Zip	:	03770-5250
Country	:	US
Telephone Number	:	603-469-2141
Fax Number	:	603-469-2046

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	07/08/2007

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