Provider Demographics
NPI:1114487121
Name:BOULDIN, ABBY (ATC)
Entity Type:Individual
Prefix:
First Name:ABBY
Middle Name:
Last Name:BOULDIN
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 1:648 OTTER WAY
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-7112
Mailing Address - Country:US
Mailing Address - Phone:630-272-2733
Mailing Address - Fax:
Practice Address - Street 1:701 W SCHICK RD
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:IL
Practice Address - Zip Code:60103-3046
Practice Address - Country:US
Practice Address - Phone:630-372-4620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer