Provider Demographics
NPI:1083244636
Name:WILLMOTT, KATIE DEE (ATC)
Entity Type:Individual
Prefix:MS
First Name:KATIE
Middle Name:DEE
Last Name:WILLMOTT
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:PO BOX 284
Mailing Address - Street 2:
Mailing Address - City:PLATTE
Mailing Address - State:SD
Mailing Address - Zip Code:57369-0284
Mailing Address - Country:US
Mailing Address - Phone:605-337-3102
Mailing Address - Fax:605-337-3104
Practice Address - Street 1:318 S MAIN AVE STE 1
Practice Address - Street 2:
Practice Address - City:PLATTE
Practice Address - State:SD
Practice Address - Zip Code:57369-2120
Practice Address - Country:US
Practice Address - Phone:605-337-3102
Practice Address - Fax:605-337-3104
Is Sole Proprietor?:No
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD04802255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer