Provider Demographics
NPI:1639201403
Name:MEDLEY, ERIN (ATC)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:MEDLEY
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 1:533 LILY LN
Mailing Address - Street 2:
Mailing Address - City:LAKEMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60051-8867
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:533 LILY LN
Practice Address - Street 2:
Practice Address - City:LAKEMOOR
Practice Address - State:IL
Practice Address - Zip Code:60051-8867
Practice Address - Country:US
Practice Address - Phone:815-344-5616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL960023762255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer