Individual
KYLA RAYE STANCY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
385 WINNETKA AVE, WINNETKA, IL 60093-4238
(847) 784-6601
Mailing address
8233 N OCTAVIA AVE, NILES, IL 60714-2624
(847) 529-4119
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096.003818
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
096.003818
LICENCED ATHLETIC TRAINER
IL
Enumeration date
07/06/2018
Last updated
07/06/2018
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