MEDICARE: SHARI LYNAE STEENWYK MS, 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
1	2255A2300X	Athletic Trainer		IL

General Provider Information

NPI Number	:	1619946274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARI LYNAE STEENWYK MS, ATC, CSCS

Provider Business Mailing Address
First Line	:	2303 DESPLAINES ST
Second Line	:
City	:	BLUE ISLAND
State	:	IL
Zip	:	60406-2910
Country	:	US
Telephone Number	:	708-388-9129
Fax Number	:	708-396-7460

Provider Business Practice Location Address
First Line	:	6601 W COLLEGE DR
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1768
Country	:	US
Telephone Number	:	708-293-4920
Fax Number	:	708-396-7460

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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