MEDICARE: JESSICA RENEE TRCKA

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	36002253A

General Provider Information

NPI Number	:	1952714297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA RENEE TRCKA

Provider Business Mailing Address
First Line	:	851 WATER ST
Second Line	:
City	:	HOBART
State	:	IN
Zip	:	46342-5922
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2211 E 10TH ST
Second Line	:
City	:	HOBART
State	:	IN
Zip	:	46342-5313
Country	:	US
Telephone Number	:	219-942-8521
Fax Number	:

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

Provider Enumeration Date	:	06/04/2014
Last Update Date	:	06/04/2014

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