Provider Demographics
NPI:1932505989
Name:HARRELL, DANA BARENTS (ATC, OPA-C)
Entity Type:Individual
Prefix:MISS
First Name:DANA
Middle Name:BARENTS
Last Name:HARRELL
Suffix:
Gender:F
Credentials:ATC, OPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 BRADFORD LN
Mailing Address - Street 2:#140
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-5283
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1715 BRADFORD LN
Practice Address - Street 2:#140
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-5283
Practice Address - Country:US
Practice Address - Phone:309-275-3802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-18
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0960037962255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
1018849OtherNATA CERTIFICATION NUMBER
110754OtherBOARD OF CERTIFICATION ATC