=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710575220
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRISTI NICHOLE ZABKA ATC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2021
-----------------------------------------------------
Last Update Date | 01/10/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 115 E OGDEN AVE
-----------------------------------------------------
City | NAPERVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60563-3103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-637-0144
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1078 PUEBLO DR
-----------------------------------------------------
City | BATAVIA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60510-1148
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-487-7690
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2255A2300X
-----------------------------------------------------
Taxonomy Name | Athletic Trainer
-----------------------------------------------------
License Number | 096.005154
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------