MEDICARE: COURTNEY SILL COURTEMANCHE 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	A0000235	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	070002085	OTHER		BOARD OF CERTIFICATION, INC.

General Provider Information

NPI Number	:	1962495309
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY SILL COURTEMANCHE ATC

Provider Business Mailing Address
First Line	:	6213 FAIRBOURNE CT
Second Line	:
City	:	HANOVER
State	:	MD
Zip	:	21076-1053
Country	:	US
Telephone Number	:	301-367-0963
Fax Number	:

Provider Business Practice Location Address
First Line	:	6213 FAIRBOURNE CT
Second Line	:
City	:	HANOVER
State	:	MD
Zip	:	21076-1053
Country	:	US
Telephone Number	:	301-367-0963
Fax Number	:

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

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	05/27/2019

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