MEDICARE: MRS. JENNIFER LYNN MCCRABB A.T.C.

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	RT 000829A	PA

General Provider Information

NPI Number	:	1568548600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER LYNN MCCRABB A.T.C.

Provider Business Mailing Address
First Line	:	59 DEERFIELD DR
Second Line	:
City	:	PEQUEA
State	:	PA
Zip	:	17565-9625
Country	:	US
Telephone Number	:	717-284-3523
Fax Number	:

Provider Business Practice Location Address
First Line	:	1107 VILLAGE RD
Second Line	:
City	:	LAMPETER
State	:	PA
Zip	:	17537-0428
Country	:	US
Telephone Number	:	717-464-3311
Fax Number	:

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

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	07/08/2007

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