Provider Demographics
NPI:1114442985
Name:DILLER, NATHANIEL DAVID (ATC)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:DAVID
Last Name:DILLER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 E ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:KS
Mailing Address - Zip Code:67579-1914
Mailing Address - Country:US
Mailing Address - Phone:567-242-8912
Mailing Address - Fax:
Practice Address - Street 1:125 W COOPER ST
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:KS
Practice Address - Zip Code:67579-1533
Practice Address - Country:US
Practice Address - Phone:567-242-8912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-13
Last Update Date:2017-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
2000027440OtherBOC