MEDICARE: MISS ANITA MURRAY BEAUCHAMP MA, 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

General Provider Information

NPI Number	:	1699987685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ANITA MURRAY BEAUCHAMP MA, ATC

Provider Business Mailing Address
First Line	:	6410 EDWOOD AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45224-2106
Country	:	US
Telephone Number	:	513-470-8258
Fax Number	:	513-541-0343

Provider Business Practice Location Address
First Line	:	6410 EDWOOD AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45224-2106
Country	:	US
Telephone Number	:	513-470-8258
Fax Number	:	513-541-0343

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

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	05/04/2017

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