MEDICARE: CASEY JORDAN SEITZ 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	AL6020	FL
2	2255A2300X	Athletic Trainer	765	OK
3	2255A2300X	Athletic Trainer	1248	OK

General Provider Information

NPI Number	:	1194369991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASEY JORDAN SEITZ ATC

Provider Business Mailing Address
First Line	:	2801 NW 27TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73107-2106
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2801 NW 27TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73107-2199
Country	:	US
Telephone Number	:	405-587-6300
Fax Number	:

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

Provider Enumeration Date	:	11/05/2019
Last Update Date	:	09/13/2021

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