Provider Demographics
NPI:1609451293
Name:SCHAEFFER, KIMBERLY (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:SCHAEFFER
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 LOCUST CT
Mailing Address - Street 2:
Mailing Address - City:SOUTH ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60177-2875
Mailing Address - Country:US
Mailing Address - Phone:847-845-1001
Mailing Address - Fax:
Practice Address - Street 1:901 N EDGELAWN DR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-1819
Practice Address - Country:US
Practice Address - Phone:630-896-0831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0960051032255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer