Healthcare Provider Details

I. General information

NPI: 1871139949
Provider Name (Legal Business Name): MERYL SWIDLER ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MERYL SWIDLER ATC

II. Dates (important events)

Enumeration Date: 11/22/2019
Last Update Date: 11/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44W625 PLATO RD
BURLINGTON IL
60109-1086
US

IV. Provider business mailing address

222 WOODLAND PARK CIR
GILBERTS IL
60136-4012
US

V. Phone/Fax

Practice location:
  • Phone: 847-464-6038
  • Fax:
Mailing address:
  • Phone: 847-529-4414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225500000X
TaxonomyRespiratory/Developmental/Rehabilitative Specialist/Technologist
License Number096.005073
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: