Dara De Boer, ATC
Individual provider Active NPI Athletic Trainer · Watseka, IL
NPI 1437242526 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1437242526
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- Practice address
- 110 S 3Rd St
Watseka, IL 60970-1666 - Phone
- (815) 432-2051
- Fax
- (815) 432-2069
- NPI assigned
- Oct 2, 2006
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 096001872 | IL | MD | Athletic Trainer |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Iroquois Memorial Hospital | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | IL | Yes |
Addresses
Primary practice location
110 S 3Rd St
Watseka, IL 60970-1666
Mailing address
819 W Lafayette St
Apt. 65
Watseka, IL 60970-1081
Other providers in Watseka, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.