MEDICARE: KELSEY CHRISTINE EVERHART 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	AT5852	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	22	OTHER		RESPIRATORY, REHABILITATIVE & RESTORATIVE SERVICE PROVIDERS

General Provider Information

NPI Number	:	1205243094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY CHRISTINE EVERHART LAT, ATC

Provider Business Mailing Address
First Line	:	6959 ELAINE AVE NW
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-6620
Country	:	US
Telephone Number	:	330-323-6562
Fax Number	:

Provider Business Practice Location Address
First Line	:	6959 ELAINE AVE NW
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-6620
Country	:	US
Telephone Number	:	330-323-6562
Fax Number	:

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

Provider Enumeration Date	:	07/14/2014
Last Update Date	:	07/14/2014

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