MEDICARE: MRS. CAROL JAY NAVARRO PTA,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	96000303	IL

General Provider Information

NPI Number	:	1790817369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAROL JAY NAVARRO PTA,ATC

Provider Business Mailing Address
First Line	:	118 CINDERFORD CT
Second Line	:
City	:	OSWEGO
State	:	IL
Zip	:	60543-8718
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	413 CHICAGO ROAD
Second Line	:	NEWARK HIGH SCHOOL
City	:	NEWARK
State	:	IL
Zip	:	60541
Country	:	US
Telephone Number	:	815-695-5164
Fax Number	:

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

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	07/08/2007

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