MEDICARE: MS. REBECCA LYNN KUJAWA ATC, CSCS, CHES

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	:	1548239171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. REBECCA LYNN KUJAWA ATC, CSCS, CHES

Provider Business Mailing Address
First Line	:	10858 S WASHTENAW AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60655-1731
Country	:	US
Telephone Number	:	773-779-4440
Fax Number	:

Provider Business Practice Location Address
First Line	:	3737 W 99TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60655-3133
Country	:	US
Telephone Number	:	773-881-6564
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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