Basic Information
| Provider Information | |||||||||
| NPI: | 1801489547 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MENDEZ-AVILA | ||||||||
| FirstName: | KAREN | ||||||||
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| Credential: | ATC, ROT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1522 GOLDEN OAK DR | ||||||||
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| City: | WOODSTOCK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600987712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153373670 | ||||||||
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| Practice Location | |||||||||
| Address1: | 650 S RANDALL RD | ||||||||
| Address2: | |||||||||
| City: | ALGONQUIN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601025944 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153989491 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2021 | ||||||||
| LastUpdateDate: | 04/16/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | 2000039576 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.