MEDICARE: MS. KATHERINE J WOLFE MS, 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2255A2300X	OTHER	CA	REHABILITATION TECHNICIAN

General Provider Information

NPI Number	:	1972569093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHERINE J WOLFE MS, ATC

Provider Business Mailing Address
First Line	:	1187 COAST VILLAGE RD
Second Line	:	#1-464
City	:	SANTA BARBARA
State	:	CA
Zip	:	93108-2737
Country	:	US
Telephone Number	:	805-895-5841
Fax Number	:

Provider Business Practice Location Address
First Line	:	1187 COAST VILLAGE RD
Second Line	:	#1-464
City	:	SANTA BARBARA
State	:	CA
Zip	:	93108-2737
Country	:	US
Telephone Number	:	805-895-5841
Fax Number	:

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

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	07/08/2007

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