Provider Demographics
NPI:1033574595
Name:PLANTZ, KATELIN
Entity Type:Individual
Prefix:
First Name:KATELIN
Middle Name:
Last Name:PLANTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2049 VALLEY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-2687
Mailing Address - Country:US
Mailing Address - Phone:847-849-0362
Mailing Address - Fax:
Practice Address - Street 1:2049 VALLEY CREEK DR
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-2687
Practice Address - Country:US
Practice Address - Phone:847-849-0362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-28
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer