MEDICARE: WILLIAM DANIELSON

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

General Provider Information

NPI Number	:	1477900538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM DANIELSON

Provider Business Mailing Address
First Line	:	530 MOON LAKE DR
Second Line	:	APT #11
City	:	RICE LAKE
State	:	WI
Zip	:	54868-2419
Country	:	US
Telephone Number	:	320-226-6684
Fax Number	:

Provider Business Practice Location Address
First Line	:	530 MOON LAKE DR
Second Line	:	APT #11
City	:	RICE LAKE
State	:	WI
Zip	:	54868-2419
Country	:	US
Telephone Number	:	320-226-6684
Fax Number	:

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

Provider Enumeration Date	:	05/18/2016
Last Update Date	:	05/18/2016

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