MEDICARE: MS. SEANTA RENITTA CLEVELAND 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	A0000802	MD

General Provider Information

NPI Number	:	1174798250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SEANTA RENITTA CLEVELAND ATC, LAT

Provider Business Mailing Address
First Line	:	5602 AUTH WAY
Second Line	:
City	:	CAMP SPRINGS
State	:	MD
Zip	:	20746-4220
Country	:	US
Telephone Number	:	404-493-1673
Fax Number	:

Provider Business Practice Location Address
First Line	:	5602 AUTH WAY
Second Line	:
City	:	CAMP SPRINGS
State	:	MD
Zip	:	20746
Country	:	US
Telephone Number	:	404-493-1673
Fax Number	:

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

Provider Enumeration Date	:	04/29/2008
Last Update Date	:	03/09/2017

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