Healthcare Provider Details

I. General information

NPI: 1922071950
Provider Name (Legal Business Name): LELIA M SIANO ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 01/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 W WACKER DR STE 1020
CHICAGO IL
60606-1452
US

IV. Provider business mailing address

810 SPRUCE ST
AURORA IL
60506-3744
US

V. Phone/Fax

Practice location:
  • Phone: 708-595-9418
  • Fax: 630-724-0978
Mailing address:
  • Phone: 708-606-6053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number096-000371
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number096000371
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: