Basic Information
| Provider Information | |||||||||
| NPI: | 1548667538 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHAEFER | ||||||||
| FirstName: | KRISTIN | ||||||||
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| Credential: | ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1111 PINE RIDGE CT | ||||||||
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| City: | NORMAL | ||||||||
| State: | IL | ||||||||
| PostalCode: | 617613965 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 23915 W MAIN ST | ||||||||
| Address2: | SUITE C | ||||||||
| City: | PLAINFIELD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605441967 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8156090570 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2014 | ||||||||
| LastUpdateDate: | 12/08/2015 | ||||||||
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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 | 096.003864 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.