MEDICARE: STEVEN CHARLES FOSTER ATC, LAT

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	AT000046	OH

General Provider Information

NPI Number	:	1689705501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN CHARLES FOSTER ATC, LAT

Provider Business Mailing Address
First Line	:	3398 HERITAGE TRACE DR W
Second Line	:
City	:	BELLBROOK
State	:	OH
Zip	:	45305-9775
Country	:	US
Telephone Number	:	937-848-9107
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 COLLEGE PARK AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45409-2670
Country	:	US
Telephone Number	:	937-229-4401
Fax Number	:

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

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	07/08/2007

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