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NPI Code Detail

MEDICARE: KATIE MATSON HAMBERG ATC

MEDICARE:   KATIE MATSON HAMBERG  ATC
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
12255A2300XAthletic TrainerAT 002289OH

General Provider Information

NPI Number : 1003816653
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATIE MATSON HAMBERG ATC
Provider Business Mailing Address
First Line : 4701 CREEK RD
Second Line : SUITE 110
City : CINCINNATI
State : OH
Zip : 45242-8398
Country : US
Telephone Number : 513-733-9333
Fax Number : 513-588-2479
Provider Business Practice Location Address
First Line : 4701 CREEK RD
Second Line : SUITE 110
City : CINCINNATI
State : OH
Zip : 45242-8398
Country : US
Telephone Number : 513-554-8080
Fax Number : 513-554-8082
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2005
Last Update Date : 12/23/2010

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Directions to “ KATIE MATSON HAMBERG ATC” Practice Location

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