Individual
MICHELLE THERESE NOVAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
2338 W VAN WINKLE WAY STE 3300, PEORIA, IL 61615-7485
(309) 693-2020
Mailing address
1700 W HICKORY GROVE RD APT 4-203, DUNLAP, IL 61525-9189
(309) 830-3250
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096003270
IL
Other
Enumeration date
11/10/2017
Last updated
11/10/2017
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