Provider Demographics
NPI:1407992522
Name:JILEK, CARRIE LEONE (ATC)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:LEONE
Last Name:JILEK
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 1:3159 CLARK RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KS
Mailing Address - Zip Code:66080-9196
Mailing Address - Country:US
Mailing Address - Phone:785-835-6505
Mailing Address - Fax:
Practice Address - Street 1:1120 S ASH ST
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:KS
Practice Address - Zip Code:66067-3415
Practice Address - Country:US
Practice Address - Phone:785-229-8020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS24-001792255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer