MEDICARE: MS. KEIR E HOWLAND 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	25MT00106700	NJ

General Provider Information

NPI Number	:	1417111378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KEIR E HOWLAND ATC

Provider Business Mailing Address
First Line	:	1000 MORRIS AVE
Second Line	:	D103
City	:	UNION
State	:	NJ
Zip	:	07083-7133
Country	:	US
Telephone Number	:	908-737-5450
Fax Number	:	908-737-5455

Provider Business Practice Location Address
First Line	:	1000 MORRIS AVE
Second Line	:	D103
City	:	UNION
State	:	NJ
Zip	:	07083-7133
Country	:	US
Telephone Number	:	908-737-5450
Fax Number	:	908-737-5455

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

Provider Enumeration Date	:	07/10/2008
Last Update Date	:	07/10/2008

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