Provider Demographics
NPI:1184997017
Name:GARTNER, KATELIN
Entity type:Individual
Prefix:
First Name:KATELIN
Middle Name:
Last Name:GARTNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 PARK PL
Mailing Address - Street 2:APT B
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-2271
Mailing Address - Country:US
Mailing Address - Phone:618-713-6445
Mailing Address - Fax:
Practice Address - Street 1:222 PARK PL
Practice Address - Street 2:APT B
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-2271
Practice Address - Country:US
Practice Address - Phone:618-713-6445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0960032542255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer