MEDICARE: MR. KARL KAPCHINSKI LAT 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	0490	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0490	OTHER	TX	LICENSED ATHLETIC TRAINER

General Provider Information

NPI Number	:	1427020379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KARL KAPCHINSKI LAT ATC

Provider Business Mailing Address
First Line	:	1517 BLUEBONNET DR
Second Line	:
City	:	COLLEGE STATION
State	:	TX
Zip	:	77845-7102
Country	:	US
Telephone Number	:	979-845-3121
Fax Number	:

Provider Business Practice Location Address
First Line	:	161 WELLBORN RD
Second Line	:	TEXAS A & M UNIVERSITY
City	:	COLLEGE STATION
State	:	TX
Zip	:	77843-0001
Country	:	US
Telephone Number	:	979-845-3121
Fax Number	:	979-847-8514

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

Provider Enumeration Date	:	02/05/2006
Last Update Date	:	07/08/2007

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