MEDICARE: MS. SUZANNE D. ENOS M.S., 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	AT453	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	22	OTHER	KY	RESPIRATORY, REHABILITATI

General Provider Information

NPI Number	:	1104958396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUZANNE D. ENOS M.S., ATC

Provider Business Mailing Address
First Line	:	4104 STONY RIDGE RD
Second Line	:	#22
City	:	LOUISVILLE
State	:	KY
Zip	:	40299-7336
Country	:	US
Telephone Number	:	502-299-4775
Fax Number	:

Provider Business Practice Location Address
First Line	:	2001 NEWBURG RD
Second Line	:	KNIGHTS HALL
City	:	LOUISVILLE
State	:	KY
Zip	:	40205-1863
Country	:	US
Telephone Number	:	502-452-8379
Fax Number	:

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

Provider Enumeration Date	:	03/12/2007
Last Update Date	:	07/08/2007

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