MEDICARE: MISS KATHRYN M CAMPMAN ATC, SCAT

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
2	2255A2300X	Athletic Trainer	2000031633

General Provider Information

NPI Number	:	1114395183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS KATHRYN M CAMPMAN ATC, SCAT

Provider Business Mailing Address
First Line	:	7576 REGINA CT
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29572-8005
Country	:	US
Telephone Number	:	843-492-1047
Fax Number	:

Provider Business Practice Location Address
First Line	:	4990 TULIP GROVE RD
Second Line	:
City	:	GREEN SEA
State	:	SC
Zip	:	29545-4977
Country	:	US
Telephone Number	:	843-492-1047
Fax Number	:

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

Provider Enumeration Date	:	09/09/2015
Last Update Date	:	01/02/2019

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