MEDICARE: KATIE CORNELL

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

General Provider Information

NPI Number	:	1003386137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE CORNELL

Provider Business Mailing Address
First Line	:	2862 DEERHAVEN DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45244-2819
Country	:	US
Telephone Number	:	513-562-7891
Fax Number	:

Provider Business Practice Location Address
First Line	:	2862 DEERHAVEN DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45244-4524
Country	:	US
Telephone Number	:	513-562-7891
Fax Number	:

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

Provider Enumeration Date	:	12/02/2018
Last Update Date	:	12/02/2018

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Directions to “ KATIE CORNELL ” Practice Location

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