Provider Demographics
NPI:1770591919
Name:SEVILLE, NATHANIEL EDWARD (MAED, ATC/L)
Entity type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:EDWARD
Last Name:SEVILLE
Suffix:
Gender:M
Credentials:MAED, ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:517 LIVINGSTON DR
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-1626
Mailing Address - Country:US
Mailing Address - Phone:708-250-3272
Mailing Address - Fax:
Practice Address - Street 1:790 REMINGTON BLVD
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-4909
Practice Address - Country:US
Practice Address - Phone:630-296-2222
Practice Address - Fax:205-482-3605
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096.0024042255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer