MEDICARE: KARA MICHELLE FREY PA-C, ATC-L

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	AT609	KY
2	363A00000X	Physician Assistant	PA9107965	FL
3	363A00000X	Physician Assistant	50.005088RX	OH

General Provider Information

NPI Number	:	1407078520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARA MICHELLE FREY PA-C, ATC-L

Provider Business Mailing Address
First Line	:	7777 YANKEE RD.
Second Line	:	ML 16062
City	:	LIBERTY TOWNSHIP
State	:	OH
Zip	:	45044-3500
Country	:	US
Telephone Number	:	513-636-3200
Fax Number	:	513-803-1111

Provider Business Practice Location Address
First Line	:	7777 YANKEE RD
Second Line	:
City	:	LIBERTY TOWNSHIP
State	:	OH
Zip	:	45044-3500
Country	:	US
Telephone Number	:	513-636-3200
Fax Number	:	513-803-1111

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

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	07/21/2022

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