MEDICARE: MRS. KRISTIN DAWN PILA 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	096001364	IL

General Provider Information

NPI Number	:	1811029747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTIN DAWN PILA ATC

Provider Business Mailing Address
First Line	:	9829 S KILBOURN AVE
Second Line	:
City	:	OAK LAWN
State	:	IL
Zip	:	60453-3528
Country	:	US
Telephone Number	:	312-399-1546
Fax Number	:

Provider Business Practice Location Address
First Line	:	8015 W 111TH ST
Second Line	:
City	:	PALOS HILLS
State	:	IL
Zip	:	60465-2203
Country	:	US
Telephone Number	:	312-399-1546
Fax Number	:

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

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	01/13/2015

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