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General NPI Number Information
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NPI Number | 1194295402
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Entity Type | Individual
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Provider Name | KIERSTIN TOTH
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Gender | Female
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Dates
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Enumeration Date | 11/29/2018
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Last Update Date | 11/19/2020
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Provider Practice Location Address
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Address Line | 444 W JACKSON BLVD
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City | CHICAGO
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State | IL
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Zip | 60606-6923
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Country | US
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Telephone | 312-407-0143
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Fax |
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Provider Business Mailing Address
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Address Line | 8837 MAJOR AVE
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City | MORTON GROVE
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State | IL
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Zip | 60053-2531
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Country | US
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Telephone | 847-542-1486
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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 | 096.004940
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License Number State | IL
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