MEDICARE: MISS JESSICA KRISTINE SCOTT 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	RTO000021	PA

General Provider Information

NPI Number	:	1093859365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JESSICA KRISTINE SCOTT ATC

Provider Business Mailing Address
First Line	:	2910 W WASHINGTON ST
Second Line	:
City	:	NEW CASTLE
State	:	PA
Zip	:	16101-1019
Country	:	US
Telephone Number	:	724-510-1155
Fax Number	:

Provider Business Practice Location Address
First Line	:	1431 SARATOGA AVE APT 6
Second Line	:
City	:	STAR CITY
State	:	WV
Zip	:	26505-3181
Country	:	US
Telephone Number	:	724-510-1155
Fax Number	:

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

Provider Enumeration Date	:	02/19/2007
Last Update Date	:	07/08/2007

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