Provider Demographics
NPI:1871731604
Name:POWELL, KAMMY JANE (MS, ATC)
Entity type:Individual
Prefix:
First Name:KAMMY
Middle Name:JANE
Last Name:POWELL
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:723 MERIDIAN CT
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-8275
Mailing Address - Country:US
Mailing Address - Phone:815-762-7240
Mailing Address - Fax:815-753-2415
Practice Address - Street 1:1200 N STADIUM DR
Practice Address - Street 2:YORDON CENTER NORTHERN ILLINOIS UNIVERSITY SPORTS MEDIC
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-6079
Practice Address - Country:US
Practice Address - Phone:815-762-7240
Practice Address - Fax:815-753-2415
Is Sole Proprietor?:No
Enumeration Date:2009-02-02
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL096.0020462255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer