MEDICARE: KARL H QUILLIGAN 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	AT1713	KY
2	2255A2300X	Athletic Trainer	AT005589	OH

General Provider Information

NPI Number	:	1386262939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARL H QUILLIGAN ATC, LAT

Provider Business Mailing Address
First Line	:	3250 VICTORY PKWY
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45207-1457
Country	:	US
Telephone Number	:	513-363-8447
Fax Number	:

Provider Business Practice Location Address
First Line	:	3250 VICTORY PKWY
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45207-1457
Country	:	US
Telephone Number	:	513-363-8447
Fax Number	:

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

Provider Enumeration Date	:	07/10/2020
Last Update Date	:	11/09/2021

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