MEDICARE: MS. KRISTIN A WOITTE 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	A160047792	WA

General Provider Information

NPI Number	:	1366593261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KRISTIN A WOITTE ATC

Provider Business Mailing Address
First Line	:	PO BOX 2953
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98668-2953
Country	:	US
Telephone Number	:	360-461-0259
Fax Number	:

Provider Business Practice Location Address
First Line	:	1933 FORT VANCOUVER WAY
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98663-3529
Country	:	US
Telephone Number	:	360-992-2913
Fax Number	:

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

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	09/15/2019

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