MEDICARE: MRS. KATIE MARIE WESER MED, AT, ATC, 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	AT-002433	OH

General Provider Information

NPI Number	:	1962623587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATIE MARIE WESER MED, AT, ATC, CSCS

Provider Business Mailing Address
First Line	:	4377 TIMBERWILDE DR
Second Line	:
City	:	KETTERING
State	:	OH
Zip	:	45440-1506
Country	:	US
Telephone Number	:	937-901-8816
Fax Number	:

Provider Business Practice Location Address
First Line	:	2400 MIAMI VALLEY DR # 160
Second Line	:
City	:	CENTERVILLE
State	:	OH
Zip	:	45459-4774
Country	:	US
Telephone Number	:	937-312-1661
Fax Number	:

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

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	06/03/2020

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