Individual
SARAH DIANE SUPPES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
400 RIVERSIDE DR STE 1600, BOURBONNAIS, IL 60914-5406
(815) 802-7090
Mailing address
397 MEADOWS RD N, BOURBONNAIS, IL 60914-1158
(815) 975-0574
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096.005098
IL
Other
Enumeration date
04/21/2021
Last updated
04/21/2021
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