Provider Demographics
NPI:1093782948
Name:BLAKEY, CHRISTINE ANNE (ATC)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:ANNE
Last Name:BLAKEY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:MISS
Other - First Name:CHRISTINE
Other - Middle Name:ANNE
Other - Last Name:GOYETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:33365 N VALLEY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-2908
Mailing Address - Country:US
Mailing Address - Phone:262-497-7727
Mailing Address - Fax:847-223-6098
Practice Address - Street 1:33365 N VALLEY VIEW DR
Practice Address - Street 2:
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-2908
Practice Address - Country:US
Practice Address - Phone:262-497-7727
Practice Address - Fax:847-223-6098
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer