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General NPI Number Information
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NPI Number | 1538799895
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Entity Type | Individual
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Provider Name | KORTNEY KATHLEEN MARSZALEK RDMS
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Gender | Female
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Dates
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Enumeration Date | 01/24/2020
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Last Update Date | 01/24/2020
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Provider Practice Location Address
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Address Line | 9645 LINCOLNWAY LN
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City | FRANKFORT
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State | IL
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Zip | 60423-1866
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Country | US
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Telephone | 815-534-5411
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1046
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City | NEW LENOX
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State | IL
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Zip | 60451-6046
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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 | 156FX1100X
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Taxonomy Name | Ophthalmic Technician/Technologist
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License Number | 180180
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License Number State | IL
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