Provider Demographics
NPI:1871843094
Name:COATY, KELLY R (ATC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:R
Last Name:COATY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 VILLAGE GRN
Mailing Address - Street 2:SUITE 120 B
Mailing Address - City:LINCOLNSHIRE
Mailing Address - State:IL
Mailing Address - Zip Code:60069-3094
Mailing Address - Country:US
Mailing Address - Phone:847-634-2317
Mailing Address - Fax:847-634-2376
Practice Address - Street 1:100 VILLAGE GRN
Practice Address - Street 2:SUITE 120 B
Practice Address - City:LINCOLNSHIRE
Practice Address - State:IL
Practice Address - Zip Code:60069-3094
Practice Address - Country:US
Practice Address - Phone:847-634-2317
Practice Address - Fax:847-634-2376
Is Sole Proprietor?:No
Enumeration Date:2012-09-14
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096.0028352255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer