Provider Demographics
NPI:1114076544
Name:BAETEN, EVA ANNE (ATC)
Entity Type:Individual
Prefix:MISS
First Name:EVA
Middle Name:ANNE
Last Name:BAETEN
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 1:1544 N LA SALLE DR
Mailing Address - Street 2:#202
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-6308
Mailing Address - Country:US
Mailing Address - Phone:312-523-7026
Mailing Address - Fax:
Practice Address - Street 1:1527 N WELLS ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-1307
Practice Address - Country:US
Practice Address - Phone:312-642-8114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL960021462255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer