Basic Information
| Provider Information | |||||||||
| NPI: | 1063656163 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MECKSTROTH | ||||||||
| FirstName: | NATALIE | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MA, ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1525 W LINCOLN HWY | ||||||||
| Address2: | |||||||||
| City: | DEKALB | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601153989 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8157539477 | ||||||||
| FaxNumber: | 8157531402 | ||||||||
| Practice Location | |||||||||
| Address1: | 1525 W LINCOLN HWY | ||||||||
| Address2: | |||||||||
| City: | DEKALB | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601153989 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8157539477 | ||||||||
| FaxNumber: | 8157531402 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2009 | ||||||||
| LastUpdateDate: | 04/21/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | 096.002187 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.