MEDICARE: MRS. KATHLEEN MARIE WILLIAMS MA, LAT, CSCS

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	RT002204A	PA

General Provider Information

NPI Number	:	1922169481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHLEEN MARIE WILLIAMS MA, LAT, CSCS

Provider Business Mailing Address
First Line	:	6414 PEPPER CT
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16505-2672
Country	:	US
Telephone Number	:	937-672-8732
Fax Number	:

Provider Business Practice Location Address
First Line	:	109 UNIVERSITY SQ
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16541-1114
Country	:	US
Telephone Number	:	814-871-5873
Fax Number	:

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

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	05/09/2016

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