Provider Demographics
NPI:1134677784
Name:PELLIKAN, MADELINE (AT, ATC)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:PELLIKAN
Suffix:
Gender:F
Credentials:AT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:373 CARROLL ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44325-0019
Mailing Address - Country:US
Mailing Address - Phone:847-778-6632
Mailing Address - Fax:
Practice Address - Street 1:373 CARROLL ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44325-0019
Practice Address - Country:US
Practice Address - Phone:847-778-6632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-12
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT. 0050032255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer