Healthcare Provider Details

I. General information

NPI: 1508102708
Provider Name (Legal Business Name): KARI TAGGART MS, ATC, OTC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2012
Last Update Date: 12/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 SCIENCE DR
MADISON WI
53711-1074
US

IV. Provider business mailing address

8418 ISAAC DR APT 206
MADISON WI
53717-2691
US

V. Phone/Fax

Practice location:
  • Phone: 608-265-8303
  • Fax:
Mailing address:
  • Phone: 734-320-9070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1366-39
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number96002668
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: