Provider Demographics
NPI:1568145597
Name:PARKINS, PAIGE MICHELLE (MAT, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:MICHELLE
Last Name:PARKINS
Suffix:
Gender:F
Credentials:MAT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10962 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62439-3414
Mailing Address - Country:US
Mailing Address - Phone:309-351-6010
Mailing Address - Fax:
Practice Address - Street 1:2200 JAMES ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62439-2028
Practice Address - Country:US
Practice Address - Phone:618-943-3389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer