MEDICARE: MRS. CHRISTINE A. EVERETT 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		FL

General Provider Information

NPI Number	:	1184752313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHRISTINE A. EVERETT ATC LAT

Provider Business Mailing Address
First Line	:	1355 WILLOW CREST DR
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711-2799
Country	:	US
Telephone Number	:	407-509-0751
Fax Number	:

Provider Business Practice Location Address
First Line	:	6100 OLEANDER DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32807-3437
Country	:	US
Telephone Number	:	407-482-6300
Fax Number	:

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

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	07/08/2007

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