MEDICARE: MS. ALISON D. KOTEK ATC, NASM-PES

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	96002147	IL

General Provider Information

NPI Number	:	1538136049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALISON D. KOTEK ATC, NASM-PES

Provider Business Mailing Address
First Line	:	724 COLORADO CT
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60565-5360
Country	:	US
Telephone Number	:	630-355-3873
Fax Number	:

Provider Business Practice Location Address
First Line	:	724 COLORADO CT
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60565-5360
Country	:	US
Telephone Number	:	630-355-3873
Fax Number	:

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

Provider Enumeration Date	:	03/02/2006
Last Update Date	:	07/08/2007

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