MEDICARE: ASHLEY BARTLEY

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

General Provider Information

NPI Number	:	1770256844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY BARTLEY

Provider Business Mailing Address
First Line	:	212 DOUGLAS DR
Second Line	:
City	:	TUSCOLA
State	:	IL
Zip	:	61953-2123
Country	:	US
Telephone Number	:	217-493-8811
Fax Number	:

Provider Business Practice Location Address
First Line	:	212 DOUGLAS DR
Second Line	:
City	:	TUSCOLA
State	:	IL
Zip	:	61953-2123
Country	:	US
Telephone Number	:	217-493-8811
Fax Number	:

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

Provider Enumeration Date	:	07/26/2021
Last Update Date	:	07/26/2021

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Directions to “ ASHLEY BARTLEY ” Practice Location

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