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NPI Code Detail

MEDICARE: KERRIE A SMITH A.T.C

MEDICARE: KERRIE A SMITH A.T.C
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
12255A2300XAthletic Trainer900002121CA

General Provider Information

NPI Number : 1467894204
Entity Type Code : Individual
Provider Name (Legal Business Name) : KERRIE A SMITH A.T.C
Provider Business Mailing Address
First Line : 2560 COLORADO BLVD
Second Line :
City : EAGLE ROCK
State : CA
Zip : 90041-1005
Country : US
Telephone Number : 323-255-5409
Fax Number : 323-255-5732
Provider Business Practice Location Address
First Line : 2560 COLORADO BLVD
Second Line :
City : EAGLE ROCK
State : CA
Zip : 90041-1005
Country : US
Telephone Number : 323-255-5409
Fax Number : 323-255-5732
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/22/2013
Last Update Date : 07/22/2013

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Directions to “ KERRIE A SMITH A.T.C” Practice Location

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