MEDICARE: MISS LORI BETH MEYER 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	36001031A	IN

General Provider Information

NPI Number	:	1326011156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS LORI BETH MEYER ATC, LAT

Provider Business Mailing Address
First Line	:	919 HIGHLAND AVE
Second Line	:
City	:	OAKLAND CITY
State	:	IN
Zip	:	47660-8963
Country	:	US
Telephone Number	:	812-749-1513
Fax Number	:	812-749-1589

Provider Business Practice Location Address
First Line	:	138 N LUCRETIA ST
Second Line	:
City	:	OAKLAND CITY
State	:	IN
Zip	:	47660-1038
Country	:	US
Telephone Number	:	812-749-1513
Fax Number	:	812-749-1589

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

Provider Enumeration Date	:	02/10/2006
Last Update Date	:	07/08/2007

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