MEDICARE: JESSE SCHMITT

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
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1003372566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSE SCHMITT

Provider Business Mailing Address
First Line	:	3939 W PINE BLVD APT 403
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-3272
Country	:	US
Telephone Number	:	812-630-7756
Fax Number	:

Provider Business Practice Location Address
First Line	:	3939 W PINE BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-3220
Country	:	US
Telephone Number	:	812-630-7756
Fax Number	:

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

Provider Enumeration Date	:	02/20/2019
Last Update Date	:	02/20/2019

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Directions to “ JESSE SCHMITT ” Practice Location

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