Provider Demographics
NPI:1497111769
Name:ADDY, LAURA KATHLEEN (ATC)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:KATHLEEN
Last Name:ADDY
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 1:1246 W PRATT BLVD
Mailing Address - Street 2:APT 1402
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-4363
Mailing Address - Country:US
Mailing Address - Phone:971-244-3898
Mailing Address - Fax:
Practice Address - Street 1:1501 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60208-0840
Practice Address - Country:US
Practice Address - Phone:847-467-2406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-02
Last Update Date:2016-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0960040742255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer