Provider Demographics
NPI:1487701546
Name:KAMINSKAS, MATTIE M (ATC)
Entity type:Individual
Prefix:MS
First Name:MATTIE
Middle Name:M
Last Name:KAMINSKAS
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 1:23908 MC MULLIN CIR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-2134
Mailing Address - Country:US
Mailing Address - Phone:773-428-0220
Mailing Address - Fax:
Practice Address - Street 1:365 RAIDER WAY
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-4893
Practice Address - Country:US
Practice Address - Phone:773-428-0220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL960023862255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer