MEDICARE: KRISTEN K SASENA MS, LAT, ATC, CEIS

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	36001664A	IN

General Provider Information

NPI Number	:	1720355522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN K SASENA MS, LAT, ATC, CEIS

Provider Business Mailing Address
First Line	:	3612 WASHINGTON ST
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47203-1217
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3612 WASHINGTON ST
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47203-1217
Country	:	US
Telephone Number	:	812-376-7028
Fax Number	:

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

Provider Enumeration Date	:	11/22/2011
Last Update Date	:	11/22/2011

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