MEDICARE: CHRISTINE LEE LEVREAULT 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	AT00205	RI

General Provider Information

NPI Number	:	1831164367
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE LEE LEVREAULT ATC

Provider Business Mailing Address
First Line	:	36 DARWIN ST
Second Line	:
City	:	WOONSOCKET
State	:	RI
Zip	:	02895-6314
Country	:	US
Telephone Number	:	401-766-7730
Fax Number	:

Provider Business Practice Location Address
First Line	:	20 COLLEGE RD
Second Line	:
City	:	RINDGE
State	:	NH
Zip	:	03461-5046
Country	:	US
Telephone Number	:	603-899-4366
Fax Number	:

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

Provider Enumeration Date	:	02/20/2006
Last Update Date	:	07/08/2007

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