MEDICARE: SARAH PAVER

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	:	1053708537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH PAVER

Provider Business Mailing Address
First Line	:	5S989 SHAW RD
Second Line	:
City	:	BIG ROCK
State	:	IL
Zip	:	60511-9716
Country	:	US
Telephone Number	:	630-556-3206
Fax Number	:

Provider Business Practice Location Address
First Line	:	5S989 SHAW RD
Second Line	:
City	:	BIG ROCK
State	:	IL
Zip	:	60511-9716
Country	:	US
Telephone Number	:	630-556-3206
Fax Number	:

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

Provider Enumeration Date	:	04/22/2015
Last Update Date	:	04/22/2015

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Directions to “ SARAH PAVER ” Practice Location

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