MEDICARE: MR. KEN HOWAT MS 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

General Provider Information

NPI Number	:	1104939974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KEN HOWAT MS ATC

Provider Business Mailing Address
First Line	:	1307 PATCH CT
Second Line	:
City	:	MARINA
State	:	CA
Zip	:	93933-5035
Country	:	US
Telephone Number	:	831-884-9358
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 CAMPUS CTR
Second Line	:	ATHLETIC TRAINING ROOM, BLDG 90
City	:	SEASIDE
State	:	CA
Zip	:	93955-8000
Country	:	US
Telephone Number	:	831-582-3010
Fax Number	:

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

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	07/08/2007

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