MEDICARE: MISS CATHERINE LOUISE RENELLI ATC, LAT

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	AT00240	RI

General Provider Information

NPI Number	:	1942332903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS CATHERINE LOUISE RENELLI ATC, LAT

Provider Business Mailing Address
First Line	:	1964 VILLAGE GRN S
Second Line	:	APT. B
City	:	RIVERSIDE
State	:	RI
Zip	:	02915-4036
Country	:	US
Telephone Number	:	401-383-3632
Fax Number	:

Provider Business Practice Location Address
First Line	:	1964 VILLAGE GRN S
Second Line	:	APT. B
City	:	RIVERSIDE
State	:	RI
Zip	:	02915-4036
Country	:	US
Telephone Number	:	401-383-3632
Fax Number	:

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

Provider Enumeration Date	:	03/12/2007
Last Update Date	:	07/08/2007

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