Provider Demographics
NPI:1629279195
Name:SCHULTZ, MICHELLE L (MSED, ATC)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:L
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:MSED, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 S MELROSE AVE
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-6011
Mailing Address - Country:US
Mailing Address - Phone:847-650-9764
Mailing Address - Fax:
Practice Address - Street 1:760 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTH ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60177-1702
Practice Address - Country:US
Practice Address - Phone:847-289-3760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL960021172255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer