Provider Demographics
NPI:1114395183
Name:CAMPMAN, KATHRYN M (ATC, SCAT)
Entity Type:Individual
Prefix:MISS
First Name:KATHRYN
Middle Name:M
Last Name:CAMPMAN
Suffix:
Gender:F
Credentials:ATC, SCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7576 REGINA CT
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-8005
Mailing Address - Country:US
Mailing Address - Phone:843-492-1047
Mailing Address - Fax:
Practice Address - Street 1:4990 TULIP GROVE RD
Practice Address - Street 2:
Practice Address - City:GREEN SEA
Practice Address - State:SC
Practice Address - Zip Code:29545-4977
Practice Address - Country:US
Practice Address - Phone:843-492-1047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-09
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
20000316332255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer