MEDICARE: MISS JOLENE RUWE ATC/L

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	992936	OH

General Provider Information

NPI Number	:	1710948922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JOLENE RUWE ATC/L

Provider Business Mailing Address
First Line	:	10390 HOWARD RD
Second Line	:
City	:	HARRISON
State	:	OH
Zip	:	45030-9511
Country	:	US
Telephone Number	:	513-637-0644
Fax Number	:	513-741-4712

Provider Business Practice Location Address
First Line	:	5616 CHEVIOT RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45247-7006
Country	:	US
Telephone Number	:	513-741-4700
Fax Number	:	513-741-4712

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

Provider Enumeration Date	:	03/29/2006
Last Update Date	:	07/08/2007

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