MEDICARE: MS. KATHY W HOLLOMON LAT, 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	0442	NC

General Provider Information

NPI Number	:	1922077213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHY W HOLLOMON LAT, ATC

Provider Business Mailing Address
First Line	:	3020 WHITE CLOUD CIR
Second Line	:
City	:	APEX
State	:	NC
Zip	:	27502-4065
Country	:	US
Telephone Number	:	919-306-9977
Fax Number	:

Provider Business Practice Location Address
First Line	:	123 MIDDLE CREEK PARK AVE
Second Line	:
City	:	APEX
State	:	NC
Zip	:	27539-7983
Country	:	US
Telephone Number	:	919-661-5474
Fax Number	:

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

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	07/08/2007

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