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Individual

BEVERLY FOWLER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
11624 S. MAY STREET, CHICAGO, IL 60643
(773) 291-0674
Mailing address
11624 S MAY ST, CHICAGO, IL 60643-5133

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
46007490684F
IL
390200000X
Student in an Organized Health Care Education/Training Program
Primary
46007490684F
IL

Other

Enumeration date
07/12/2017
Last updated
07/12/2017
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