MEDICARE: JOYCELYN MARIE KASTL

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	AT-413	OH

General Provider Information

NPI Number	:	1386793107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOYCELYN MARIE KASTL

Provider Business Mailing Address
First Line	:	1285 SEQUOIA CT
Second Line	:	APT A
City	:	TIPP CITY
State	:	OH
Zip	:	45371-2884
Country	:	US
Telephone Number	:	937-667-1295
Fax Number	:	937-667-4038

Provider Business Practice Location Address
First Line	:	450 N HYATT ST
Second Line	:	STE102
City	:	TIPP CITY
State	:	OH
Zip	:	45371-1433
Country	:	US
Telephone Number	:	937-667-2614
Fax Number	:	937-667-4038

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

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	07/08/2007

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