Healthcare Provider Details

I. General information

NPI: 1376943027
Provider Name (Legal Business Name): TUNISIA MACKLIN LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TUNISIA MACKLIN LMT

II. Dates (important events)

Enumeration Date: 08/31/2014
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E ARMY TRAIL RD STE 307
BLOOMINGDALE IL
60108-2138
US

IV. Provider business mailing address

201 E ARMY TRAIL RD STE 307
BLOOMINGDALE IL
60108-2138
US

V. Phone/Fax

Practice location:
  • Phone: 630-635-2189
  • Fax:
Mailing address:
  • Phone: 630-635-2189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number227008685
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number227008685
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: