Provider Demographics
NPI:1093201915
Name:KROLL, KAITLIN DANIELLE (ATC)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:DANIELLE
Last Name:KROLL
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 1:1062 VALLEY DR APT 6
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57703-4700
Mailing Address - Country:US
Mailing Address - Phone:406-465-9243
Mailing Address - Fax:
Practice Address - Street 1:501 E SAINT JOSEPH ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-3901
Practice Address - Country:US
Practice Address - Phone:406-465-9243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-03
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer