MEDICARE: DR. KAREN S HOSTETTER 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	174400000X	Specialist	AT0468	MS

General Provider Information

NPI Number	:	1538122742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAREN S HOSTETTER ATC

Provider Business Mailing Address
First Line	:	118 COLLEGE DR # 5142
Second Line	:
City	:	HATTIESBURG
State	:	MS
Zip	:	39406-0002
Country	:	US
Telephone Number	:	601-467-1156
Fax Number	:	601-266-4445

Provider Business Practice Location Address
First Line	:	118 COLLEGE DR # 5142
Second Line	:
City	:	HATTIESBURG
State	:	MS
Zip	:	39406-0002
Country	:	US
Telephone Number	:	601-467-1156
Fax Number	:	601-266-4445

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

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	01/25/2011

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