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General NPI Number Information
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NPI Number | 1346924644
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Entity Type | Individual
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Provider Name | ELENIL KAITHLYN DEYPALUBOS MSAT, ATC, CFSC
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Gender | Female
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Dates
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Enumeration Date | 06/15/2023
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Last Update Date | 09/19/2024
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Provider Practice Location Address
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Address Line | 2401 RAVINE WAY STE 200
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City | GLENVIEW
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State | IL
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Zip | 60025-7645
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Country | US
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Telephone | 847-832-6745
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Fax |
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Provider Business Mailing Address
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Address Line | 800 W STADIUM AVE
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City | WEST LAFAYETTE
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State | IN
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Zip | 47907-2046
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Country | US
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Telephone |
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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 |
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