MEDICARE: KATHLEEN TKOLETZ LAT, 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	:	1760373609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN TKOLETZ LAT, ATC

Provider Business Mailing Address
First Line	:	2525 W FITCH AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60645-3113
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 CHURCH ST
Second Line	:
City	:	LAKE ZURICH
State	:	IL
Zip	:	60047-1553
Country	:	US
Telephone Number	:	847-540-4084
Fax Number	:

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

Provider Enumeration Date	:	07/10/2025
Last Update Date	:	07/10/2025

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