MEDICARE: JASON REID SMEENK 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	:	1881687234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON REID SMEENK ATC

Provider Business Mailing Address
First Line	:	10 UPPER COLLEGE DR
Second Line	:	ORVIS ACTIVITIES CENTER
City	:	ALFRED
State	:	NY
Zip	:	14802-1137
Country	:	US
Telephone Number	:	607-587-4359
Fax Number	:	607-587-4331

Provider Business Practice Location Address
First Line	:	10 UPPER COLLEGE DR
Second Line	:	ORVIS ACTIVITIES CENTER
City	:	ALFRED
State	:	NY
Zip	:	14802-1137
Country	:	US
Telephone Number	:	607-587-4359
Fax Number	:	607-587-4331

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

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	07/08/2007

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