MEDICARE: KAY LEA FOSTER

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		MO

General Provider Information

NPI Number	:	1881728095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAY LEA FOSTER

Provider Business Mailing Address
First Line	:	3221 GLENSTONE DR
Second Line	:
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65109-8801
Country	:	US
Telephone Number	:	573-634-3811
Fax Number	:

Provider Business Practice Location Address
First Line	:	3221 GLENSTONE DR
Second Line	:
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65109-8801
Country	:	US
Telephone Number	:	573-634-3811
Fax Number	:

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

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	07/08/2007

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Directions to “ KAY LEA FOSTER ” Practice Location

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