=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467864231
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KARLA SCHOENLY LAT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/28/2014
-----------------------------------------------------
Last Update Date | 05/28/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 BRADDOCK RD
-----------------------------------------------------
City | FROSTBURG
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21532-2303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-687-3027
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 70 CENTENNIAL ST
-----------------------------------------------------
City | FROSTBURG
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21532-1234
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-697-9174
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2255A2300X
-----------------------------------------------------
Taxonomy Name | Athletic Trainer
-----------------------------------------------------
License Number | A0000116
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------