Provider Demographics
NPI:1063742831
Name:FREDERICK, LINDSAY MEGAN (ATC)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:MEGAN
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 N PLUM GROVE RD
Mailing Address - Street 2:APARTMENT 311
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4678
Mailing Address - Country:US
Mailing Address - Phone:815-222-3976
Mailing Address - Fax:
Practice Address - Street 1:1002 N PLUM GROVE RD
Practice Address - Street 2:APARTMENT 311
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4678
Practice Address - Country:US
Practice Address - Phone:815-222-3976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-30
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0960024812255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer