MEDICARE: MRS. JAMIE LYNN PLATZ 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	AT002831	OH

General Provider Information

NPI Number	:	1558517706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JAMIE LYNN PLATZ ATC

Provider Business Mailing Address
First Line	:	1342 FIELDSTONE DR
Second Line	:
City	:	ORRVILLE
State	:	OH
Zip	:	44667-9063
Country	:	US
Telephone Number	:	412-901-3969
Fax Number	:

Provider Business Practice Location Address
First Line	:	832 S MAIN ST
Second Line	:	DUNLAP COMMUNITY HOSPITAL
City	:	ORRVILLE
State	:	OH
Zip	:	44667-9527
Country	:	US
Telephone Number	:	330-682-3010
Fax Number	:	330-684-4742

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

Provider Enumeration Date	:	08/07/2008
Last Update Date	:	08/07/2008

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