Provider Demographics
NPI:1548302516
Name:BEGLEY, STEPHANIE JEAN (ATC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JEAN
Last Name:BEGLEY
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 1:462 SCHROEDER RD
Mailing Address - Street 2:
Mailing Address - City:COAL VALLEY
Mailing Address - State:IL
Mailing Address - Zip Code:61240-9432
Mailing Address - Country:US
Mailing Address - Phone:309-781-1726
Mailing Address - Fax:
Practice Address - Street 1:155 BALCERZAK DR
Practice Address - Street 2:APARTMENT 7
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-5738
Practice Address - Country:US
Practice Address - Phone:309-781-1726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN19182255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer