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General NPI Number Information
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NPI Number | 1497250922
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Entity Type | Individual
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Provider Name | ROBERT LINCOLN WOODRUFF ATC
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Gender | Male
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Dates
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Enumeration Date | 03/27/2018
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Last Update Date | 03/27/2018
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Provider Practice Location Address
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Address Line | 1050 E NORRIS DR STE 3
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City | OTTAWA
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State | IL
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Zip | 61350-1605
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Country | US
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Telephone | 815-431-5746
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Fax |
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Provider Business Mailing Address
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Address Line | 2 KILEY DR APT 32
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City | STREATOR
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State | IL
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Zip | 61364-9787
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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 | 096.004513
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License Number State | IL
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