MEDICARE: MS. AMY CLARE INGRAFFIA 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		IL

General Provider Information

NPI Number	:	1417926981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMY CLARE INGRAFFIA ATC

Provider Business Mailing Address
First Line	:	1714 W TOUHY AVE
Second Line	:	APT 3BE
City	:	CHICAGO
State	:	IL
Zip	:	60626-2418
Country	:	US
Telephone Number	:	773-973-3834
Fax Number	:

Provider Business Practice Location Address
First Line	:	2323 N SHEFFIELD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-3290
Country	:	US
Telephone Number	:	773-325-4473
Fax Number	:

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

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	07/08/2007

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