MEDICARE: JESSICA M HALL ATC

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	104-0000072	VT

General Provider Information

NPI Number	:	1417072786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA M HALL ATC

Provider Business Mailing Address
First Line	:	13 BOBOLINK CIR
Second Line	:
City	:	ESSEX JUNCTION
State	:	VT
Zip	:	05452-2233
Country	:	US
Telephone Number	:	802-578-1544
Fax Number	:

Provider Business Practice Location Address
First Line	:	4 KELLOGG RD
Second Line	:
City	:	ESSEX JUNCTION
State	:	VT
Zip	:	05452-2815
Country	:	US
Telephone Number	:	802-578-1544
Fax Number	:

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

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	07/08/2007

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