MEDICARE: CORRY KARLEN ATC, LAT

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	AT2401	TX

General Provider Information

NPI Number	:	1154723435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORRY KARLEN ATC, LAT

Provider Business Mailing Address
First Line	:	6200 HOLIDAY LN
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-6150
Country	:	US
Telephone Number	:	817-281-6504
Fax Number	:	817-520-6517

Provider Business Practice Location Address
First Line	:	6200 HOLIDAY LN
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-6150
Country	:	US
Telephone Number	:	817-281-6504
Fax Number	:	817-520-6517

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

Provider Enumeration Date	:	09/18/2014
Last Update Date	:	09/18/2014

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