Individual
KAITLIN TATE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2641 W HARRISON ST, CHICAGO, IL 60612-3420
(708) 264-1919
Mailing address
11820 S LOOMIS ST, CHICAGO, IL 60643-5041
(708) 264-1919
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
09/06/2015
Last updated
03/20/2022
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