MEDICARE: MS. TERESA CURTIS KASPAR A.T., C.

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

General Provider Information

NPI Number	:	1376601849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TERESA CURTIS KASPAR A.T., C.

Provider Business Mailing Address
First Line	:	758 HACIENDA DR
Second Line	:
City	:	CAMARILLO
State	:	CA
Zip	:	93012-5214
Country	:	US
Telephone Number	:	805-484-7612
Fax Number	:	818-348-6854

Provider Business Practice Location Address
First Line	:	7301 MEDICAL CENTER DR STE 102
Second Line	:
City	:	WEST HILLS
State	:	CA
Zip	:	91307-1917
Country	:	US
Telephone Number	:	818-340-8320
Fax Number	:	818-348-6854

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

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	07/08/2007

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