MEDICARE: ANNA HAHN 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	1747-39	WI

General Provider Information

NPI Number	:	1972076586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA HAHN LAT, ATC

Provider Business Mailing Address
First Line	:	7930 HARWOOD AVE APT 321
Second Line	:
City	:	WAUWATOSA
State	:	WI
Zip	:	53213-2571
Country	:	US
Telephone Number	:	262-853-5882
Fax Number	:

Provider Business Practice Location Address
First Line	:	18695 W CLEVELAND AVE
Second Line	:
City	:	NEW BERLIN
State	:	WI
Zip	:	53146-2231
Country	:	US
Telephone Number	:	262-789-6468
Fax Number	:

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

Provider Enumeration Date	:	01/07/2019
Last Update Date	:	01/07/2019

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