MEDICARE: VICTORIA KRAMP 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	9448186	NY
2	2255A2300X	Athletic Trainer	A0000621	MD
3	2255A2300X	Athletic Trainer	RT006104	PA

General Provider Information

NPI Number	:	1497295661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA KRAMP LAT, ATC

Provider Business Mailing Address
First Line	:	8 CROSS ST # A
Second Line	:
City	:	DELHI
State	:	NY
Zip	:	13753-1104
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8 CROSS ST # A
Second Line	:
City	:	DELHI
State	:	NY
Zip	:	13753-1104
Country	:	US
Telephone Number	:	267-251-5196
Fax Number	:

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

Provider Enumeration Date	:	03/07/2017
Last Update Date	:	03/07/2017

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