MEDICARE: MS. ALLISON LEE JUDY 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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1558334268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALLISON LEE JUDY ATC

Provider Business Mailing Address
First Line	:	5429 VILLAGE WALK CIR
Second Line	:	APT. B
City	:	TERRE HAUTE
State	:	IN
Zip	:	47803-4257
Country	:	US
Telephone Number	:	937-408-4946
Fax Number	:

Provider Business Practice Location Address
First Line	:	5429 VILLAGE WALK CIR
Second Line	:	APT. B
City	:	TERRE HAUTE
State	:	IN
Zip	:	47803-4257
Country	:	US
Telephone Number	:	937-408-4946
Fax Number	:

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

Provider Enumeration Date	:	02/12/2006
Last Update Date	:	07/08/2007

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