Provider Demographics
NPI:1699151670
Name:KEMERLING, KATIE A (PTA)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:A
Last Name:KEMERLING
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 CANYON LN
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-2545
Mailing Address - Country:US
Mailing Address - Phone:847-961-0595
Mailing Address - Fax:
Practice Address - Street 1:612 CANYON LN
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-2545
Practice Address - Country:US
Practice Address - Phone:847-961-0595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-31
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.007132225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL160.007132OtherILLINOIS STATE LICENSE