MEDICARE: KALYNN MARIE WHEELAND MS, 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	RT007479	PA

General Provider Information

NPI Number	:	1255967485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KALYNN MARIE WHEELAND MS, LAT, ATC

Provider Business Mailing Address
First Line	:	128 ANCHOR CT
Second Line	:
City	:	MC DONALD
State	:	PA
Zip	:	15057-2199
Country	:	US
Telephone Number	:	570-560-1994
Fax Number	:

Provider Business Practice Location Address
First Line	:	11 TROJAN WAY
Second Line	:
City	:	COAL CENTER
State	:	PA
Zip	:	15423-1059
Country	:	US
Telephone Number	:	724-785-5800
Fax Number	:

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

Provider Enumeration Date	:	03/19/2020
Last Update Date	:	03/19/2020

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