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General NPI Number Information
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NPI Number | 1073629341
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Entity Type | Individual
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Provider Name | JEAN ANN BAGEL ATC
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Gender | Female
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2121 S GOEBBERT RD
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City | ARLINGTON HEIGHTS
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State | IL
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Zip | 60005-4205
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Country | US
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Telephone | 847-718-4176
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Fax |
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Provider Business Mailing Address
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Address Line | 15 S PRINDLE AVE
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City | ARLINGTON HEIGHTS
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State | IL
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Zip | 60004-6537
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Country | US
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Telephone | 847-749-1932
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State | IL
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