MEDICARE: AUSTIN DODDS 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	24-01207	KS

General Provider Information

NPI Number	:	1558755298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUSTIN DODDS ATC

Provider Business Mailing Address
First Line	:	625 REDWOOD DR
Second Line	:
City	:	ROSSVILLE
State	:	KS
Zip	:	66533-9782
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 RICE RD
Second Line	:
City	:	SILVER LAKE
State	:	KS
Zip	:	66539-9682
Country	:	US
Telephone Number	:	785-582-4956
Fax Number	:

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

Provider Enumeration Date	:	03/19/2015
Last Update Date	:	11/11/2019

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