Healthcare Provider Details

I. General information

NPI: 1962470989
Provider Name (Legal Business Name): ELIZABETH J CASCHETTA MS, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W LINCOLN ST SUITE 210
BELLEVILLE IL
62220-1901
US

IV. Provider business mailing address

301 W LINCOLN ST SUITE 210
BELLEVILLE IL
62220-1901
US

V. Phone/Fax

Practice location:
  • Phone: 618-641-5800
  • Fax: 618-641-5825
Mailing address:
  • Phone: 618-641-5800
  • Fax: 618-641-5825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number96001976
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: