MEDICARE: MR. JAMIE BILLITER JR.

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
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1386045516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMIE BILLITER JR.

Provider Business Mailing Address
First Line	:	PO BOX 101
Second Line	:
City	:	NEFFS
State	:	OH
Zip	:	43940-0101
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	702 NORTH 7TH AVE
Second Line	:
City	:	PADEN CITY
State	:	WV
Zip	:	26159-0101
Country	:	US
Telephone Number	:	740-238-2818
Fax Number	:

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

Provider Enumeration Date	:	09/08/2014
Last Update Date	:	09/08/2014

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