Provider Demographics
NPI:1578526869
Name:BARTELL, SHANA RANAE (ATC)
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:RANAE
Last Name:BARTELL
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 1:1001 W MAPLEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-2045
Mailing Address - Country:US
Mailing Address - Phone:618-993-1334
Mailing Address - Fax:618-993-1334
Practice Address - Street 1:1104 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:IL
Practice Address - Zip Code:62812-1565
Practice Address - Country:US
Practice Address - Phone:618-439-3399
Practice Address - Fax:618-439-4801
Is Sole Proprietor?:No
Enumeration Date:2006-04-09
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096-0015372255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer