MEDICARE: MS. MAUREEN BURKE 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
1	2255A2300X	Athletic Trainer	RT004025	PA

General Provider Information

NPI Number	:	1023190873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MAUREEN BURKE ATC

Provider Business Mailing Address
First Line	:	539 S STATE ST
Second Line	:
City	:	CLARKS SUMMIT
State	:	PA
Zip	:	18411-1557
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	539 S STATE ST
Second Line	:
City	:	CLARKS SUMMIT
State	:	PA
Zip	:	18411-1557
Country	:	US
Telephone Number	:	570-586-4186
Fax Number	:

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

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	05/23/2016

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