Provider Demographics
NPI:1215361324
Name:RIEGNER, KELLEY (MA, ATC, OTC)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:
Last Name:RIEGNER
Suffix:
Gender:F
Credentials:MA, ATC, OTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 S FINLEY RD
Mailing Address - Street 2:APT 3L
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-4322
Mailing Address - Country:US
Mailing Address - Phone:814-573-2909
Mailing Address - Fax:
Practice Address - Street 1:1010 EXECUTIVE DR
Practice Address - Street 2:SUITE 250
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-6135
Practice Address - Country:US
Practice Address - Phone:690-794-8668
Practice Address - Fax:630-920-2382
Is Sole Proprietor?:No
Enumeration Date:2013-08-26
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096.0037982255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer