MEDICARE: SCOTT SMELSER L.A.T

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	AT 1084	TX

General Provider Information

NPI Number	:	1841493475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT SMELSER L.A.T

Provider Business Mailing Address
First Line	:	10216 BERMUDA AVE
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79925-5503
Country	:	US
Telephone Number	:	915-434-4152
Fax Number	:

Provider Business Practice Location Address
First Line	:	2430 MCRAE BLVD
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79925-6020
Country	:	US
Telephone Number	:	915-434-4152
Fax Number	:

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

Provider Enumeration Date	:	06/10/2007
Last Update Date	:	07/08/2007

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