Provider Demographics
NPI:1154459873
Name:FONTAINE, KATRINA LYNN (ATC)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:LYNN
Last Name:FONTAINE
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 1:165-A LOWER BRICK ROW
Mailing Address - Street 2:
Mailing Address - City:FORT RILEY
Mailing Address - State:KS
Mailing Address - Zip Code:66442
Mailing Address - Country:US
Mailing Address - Phone:785-784-4986
Mailing Address - Fax:
Practice Address - Street 1:1600 CHARLES PL
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-2750
Practice Address - Country:US
Practice Address - Phone:785-537-4230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer