MEDICARE: TRACY JO STEFFEN MS, LAT, 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	:	1144469545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY JO STEFFEN MS, LAT, ATC

Provider Business Mailing Address
First Line	:	100 WARTBURG BLVD
Second Line	:	DEPT. OF ATHLETICS - WARTBURG COLLEGE
City	:	WAVERLY
State	:	IA
Zip	:	50677-2215
Country	:	US
Telephone Number	:	319-352-8741
Fax Number	:	319-352-8528

Provider Business Practice Location Address
First Line	:	100 WARTBURG BLVD
Second Line	:	DEPT. OF ATHLETICS - WARTBURG COLLEGE
City	:	WAVERLY
State	:	IA
Zip	:	50677-2215
Country	:	US
Telephone Number	:	319-352-8741
Fax Number	:	319-352-8528

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

Provider Enumeration Date	:	02/10/2009
Last Update Date	:	02/10/2009

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