MEDICARE: MRS. KATE LEE ESELY 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	2004015703	MO

General Provider Information

NPI Number	:	1588693311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATE LEE ESELY ATC

Provider Business Mailing Address
First Line	:	802 N RIVERSIDE RD STE 250
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64507-2560
Country	:	US
Telephone Number	:	816-271-7676
Fax Number	:	816-271-4952

Provider Business Practice Location Address
First Line	:	5110 MOCKINGBIRD LN
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64506-3331
Country	:	US
Telephone Number	:	816-671-9517
Fax Number	:

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

Provider Enumeration Date	:	07/02/2006
Last Update Date	:	07/08/2007

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