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NPI Code Detail

MEDICARE: MS. AMY NOVAK ATC, CSCS

MEDICARE: MS. AMY NOVAK ATC, CSCS
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
12255A2300XAthletic TrainerIL

General Provider Information

NPI Number : 1184607889
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. AMY NOVAK ATC, CSCS
Provider Business Mailing Address
First Line : 15411 AUBRIETA CT
Second Line :
City : ORLAND PARK
State : IL
Zip : 60462-4315
Country : US
Telephone Number : 708-250-8458
Fax Number :
Provider Business Practice Location Address
First Line : 6255 S ARCHER AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60638-2609
Country : US
Telephone Number : 773-284-6735
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/28/2005
Last Update Date : 07/08/2007

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