MEDICARE: MS. KATHLEEN RAINEY ATHLETIC TRAINER

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	AT1578	TX

General Provider Information

NPI Number	:	1366837700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHLEEN RAINEY ATHLETIC TRAINER

Provider Business Mailing Address
First Line	:	6500 ST. STEPHEN'S DR.
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78746
Country	:	US
Telephone Number	:	512-327-1213
Fax Number	:

Provider Business Practice Location Address
First Line	:	6500 SAINT STEPHENS DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78746-1716
Country	:	US
Telephone Number	:	512-327-1213
Fax Number	:

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

Provider Enumeration Date	:	04/02/2015
Last Update Date	:	04/02/2015

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