MEDICARE: KELSEY REES 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	2255A2300X	Athletic Trainer	096003194	IL

General Provider Information

NPI Number	:	1376940692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY REES ATC

Provider Business Mailing Address
First Line	:	205 S VILLA AVE
Second Line	:
City	:	ELMHURST
State	:	IL
Zip	:	60126-3031
Country	:	US
Telephone Number	:	217-553-0706
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 S STATE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60605-1229
Country	:	US
Telephone Number	:	217-553-0706
Fax Number	:

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

Provider Enumeration Date	:	12/02/2014
Last Update Date	:	12/02/2014

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