MEDICARE: CATHLENE ELLEN VENTRESCA ATC, CFO

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	952491	OH

General Provider Information

NPI Number	:	1932311909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHLENE ELLEN VENTRESCA ATC, CFO

Provider Business Mailing Address
First Line	:	2967 AVALON RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43221-2601
Country	:	US
Telephone Number	:	614-487-1476
Fax Number	:

Provider Business Practice Location Address
First Line	:	2967 AVALON RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43221-2601
Country	:	US
Telephone Number	:	614-487-1476
Fax Number	:

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

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	07/08/2007

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