MEDICARE: CHERI BILLIOT ATC,LAT

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	096002879	IL

General Provider Information

NPI Number	:	1558770966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERI BILLIOT ATC,LAT

Provider Business Mailing Address
First Line	:	4500 W 123RD PL
Second Line	:
City	:	ALSIP
State	:	IL
Zip	:	60803-2608
Country	:	US
Telephone Number	:	773-366-6985
Fax Number	:

Provider Business Practice Location Address
First Line	:	939 W MADISON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607-2638
Country	:	US
Telephone Number	:	312-243-9351
Fax Number	:

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

Provider Enumeration Date	:	08/11/2014
Last Update Date	:	08/11/2014

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