Basic Information
| Provider Information | |||||||||
| NPI: | 1609014067 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVIES | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | REBECCA | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MS, ATC/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1603 HIGHLAND PL | ||||||||
| Address2: | |||||||||
| City: | STREATOR | ||||||||
| State: | IL | ||||||||
| PostalCode: | 613641715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3092612572 | ||||||||
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| Practice Location | |||||||||
| Address1: | 790 REMINGTON BLVD | ||||||||
| Address2: | |||||||||
| City: | BOLINGBROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604404909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6302962222 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2009 | ||||||||
| LastUpdateDate: | 08/28/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | 096.002624 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.