MEDICARE: MR. KATHRYN EVE LEMMON MS, ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	226300000X	Kinesiotherapist		IL

General Provider Information

NPI Number	:	1023091626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KATHRYN EVE LEMMON MS, ATC

Provider Business Mailing Address
First Line	:	1222 CHICAGO AVE
Second Line	:	UNIT 404
City	:	EVANSTON
State	:	IL
Zip	:	60202-6506
Country	:	US
Telephone Number	:	847-424-0046
Fax Number	:	312-951-6989

Provider Business Practice Location Address
First Line	:	1031 N CLARK ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60610-2809
Country	:	US
Telephone Number	:	312-951-9700
Fax Number	:	312-951-6989

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2005
Last Update Date	:	07/08/2007

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