MEDICARE: SARA CAITLIN GODWIN ATC, LAT, CES, CPT

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	2139	AL

General Provider Information

NPI Number	:	1205312097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA CAITLIN GODWIN ATC, LAT, CES, CPT

Provider Business Mailing Address
First Line	:	2052 VESTAVIA PARK CT APT B
Second Line	:
City	:	VESTAVIA
State	:	AL
Zip	:	35216-3218
Country	:	US
Telephone Number	:	334-559-4953
Fax Number	:

Provider Business Practice Location Address
First Line	:	2235 LIME ROCK RD
Second Line	:
City	:	VESTAVIA HILLS
State	:	AL
Zip	:	35216-3314
Country	:	US
Telephone Number	:	334-559-4953
Fax Number	:

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

Provider Enumeration Date	:	07/14/2018
Last Update Date	:	07/14/2018

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