MEDICARE: CAROL OSGOOD MS, LAT, 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	2000016005	KS

General Provider Information

NPI Number	:	1902289952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL OSGOOD MS, LAT, ATC

Provider Business Mailing Address
First Line	:	1810 CAROLINE AVE APT D205
Second Line	:
City	:	JUNCTION CITY
State	:	KS
Zip	:	66441-5251
Country	:	US
Telephone Number	:	316-323-9527
Fax Number	:

Provider Business Practice Location Address
First Line	:	7768 APENNINES DR
Second Line	:
City	:	FORT RILEY
State	:	KS
Zip	:	66442-7156
Country	:	US
Telephone Number	:	316-323-9527
Fax Number	:

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

Provider Enumeration Date	:	07/08/2015
Last Update Date	:	09/26/2024

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