MEDICARE: EMILY HALEY 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	096.005813	IL
2	390200000X	Student in an Organized Health Care Education/Training Program

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2000053383	OTHER		BOARD OF CERTIFICATION FOR THE ATHLETIC TRAINER

General Provider Information

NPI Number	:	1891456919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY HALEY ATC

Provider Business Mailing Address
First Line	:	1205 DORCHESTER DR
Second Line	:
City	:	MUNDELEIN
State	:	IL
Zip	:	60060-1038
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1205 DORCHESTER DR
Second Line	:
City	:	MUNDELEIN
State	:	IL
Zip	:	60060-1038
Country	:	US
Telephone Number	:	847-321-0672
Fax Number	:

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

Provider Enumeration Date	:	01/02/2022
Last Update Date	:	05/01/2026

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