Provider Demographics
NPI:1083103063
Name:SERPICO, KATHRYNE JOSEPHINE (ATC)
Entity Type:Individual
Prefix:
First Name:KATHRYNE
Middle Name:JOSEPHINE
Last Name:SERPICO
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4636 N OZARK AVE
Mailing Address - Street 2:
Mailing Address - City:NORRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60706-4527
Mailing Address - Country:US
Mailing Address - Phone:708-254-4978
Mailing Address - Fax:
Practice Address - Street 1:4636 N OZARK AVE
Practice Address - Street 2:
Practice Address - City:NORRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60706-4527
Practice Address - Country:US
Practice Address - Phone:708-254-4978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-06
Last Update Date:2018-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096.0042232255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty