Provider Demographics
NPI:1467887570
Name:CASEY, KEVIN WILLIAM (ATC/L)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:WILLIAM
Last Name:CASEY
Suffix:
Gender:M
Credentials:ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 N LINDEN ST
Mailing Address - Street 2:B107
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-5321
Mailing Address - Country:US
Mailing Address - Phone:309-530-4741
Mailing Address - Fax:
Practice Address - Street 1:2000 N LINDEN ST
Practice Address - Street 2:B107
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-5321
Practice Address - Country:US
Practice Address - Phone:309-530-4741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-08
Last Update Date:2013-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0960027822255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer