Provider Demographics
NPI:1578885018
Name:BRUMMETT, KRISTEN MARIE (ATC)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:MARIE
Last Name:BRUMMETT
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:MARIE
Other - Last Name:DANIELS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:ILLINOIS STATE UNIVERSITY
Mailing Address - Street 2:CAMPUS BOX 7130
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61790-0001
Mailing Address - Country:US
Mailing Address - Phone:309-438-3284
Mailing Address - Fax:
Practice Address - Street 1:ILLINOIS STATE UNIVERSITY
Practice Address - Street 2:CAMPUS BOX 7130
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61790-0001
Practice Address - Country:US
Practice Address - Phone:309-438-3284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-25
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096.0031492255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer