MEDICARE: ERIN O'BRIEN 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	096004198	OTHER	IL	ILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION

General Provider Information

NPI Number	:	1497220123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN O'BRIEN ATC

Provider Business Mailing Address
First Line	:	1405 W SAPPHIRE DR
Second Line	:
City	:	HOFFMAN ESTATES
State	:	IL
Zip	:	60192-3814
Country	:	US
Telephone Number	:	815-814-3616
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 S MCHENRY AVE
Second Line	:
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-7495
Country	:	US
Telephone Number	:	815-455-3860
Fax Number	:

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

Provider Enumeration Date	:	10/09/2018
Last Update Date	:	10/09/2018

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Directions to “ ERIN O'BRIEN ATC” Practice Location

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