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General NPI Number Information
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NPI Number | 1992870257
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Entity Type | Individual
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Provider Name | LORI CONNELL
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Gender | Female
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Dates
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Enumeration Date | 11/22/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 547 S SCHMALE RD
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City | CAROL STREAM
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State | IL
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Zip | 60188-2451
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Country | US
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Telephone | 630-462-7020
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Fax |
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Provider Business Mailing Address
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Address Line | 317 MALIBU DR
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City | BOLINGBROOK
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State | IL
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Zip | 60440-2042
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Country | US
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Telephone | 630-677-7399
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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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