MEDICARE: MR. KYLE L FARLEY 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	00127	MO

General Provider Information

NPI Number	:	1518296565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KYLE L FARLEY ATC

Provider Business Mailing Address
First Line	:	13316 E 93RD ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64138-5000
Country	:	US
Telephone Number	:	816-699-1397
Fax Number	:	816-350-2878

Provider Business Practice Location Address
First Line	:	3215 MAIN ST STE 202
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-1946
Country	:	US
Telephone Number	:	816-350-2881
Fax Number	:	816-350-2878

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

Provider Enumeration Date	:	12/21/2009
Last Update Date	:	12/21/2009

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