Individual
SAMANTHA MELILLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2070 OAK TREE TRL, LAKE VILLA, IL 60046-7569
(224) 436-0066
Mailing address
2070 OAK TREE TRL, LAKE VILLA, IL 60046-7569
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2255A2300X
SPECIALIST/TECHNOLOGIST-ATHLETIC TRAINER
OH
01
—
390200000X
STUDENT IN AN ORGANIZED TRAINING HEALTHCARE ORGANIZATION TRAINING PROGRAM
OH
Enumeration date
08/26/2016
Last updated
08/26/2016
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