MEDICARE: MRS. KATELYN BREWER RICE 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	306386	LA

General Provider Information

NPI Number	:	1497246201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATELYN BREWER RICE LAT, ATC

Provider Business Mailing Address
First Line	:	201 W GLORIA SWITCH RD STE H
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70507-2590
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 W GLORIA SWITCH RD STE H
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70507-2590
Country	:	US
Telephone Number	:	337-233-8080
Fax Number	:

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

Provider Enumeration Date	:	05/29/2018
Last Update Date	:	05/29/2018

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