Provider Demographics
NPI:1235405275
Name:MARTINE-SCHRADER, KIRSTEN N (MS ATC LAT)
Entity Type:Individual
Prefix:MRS
First Name:KIRSTEN
Middle Name:N
Last Name:MARTINE-SCHRADER
Suffix:
Gender:F
Credentials:MS ATC LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5304 BRANDERMILL CT
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-5809
Mailing Address - Country:US
Mailing Address - Phone:336-404-3919
Mailing Address - Fax:
Practice Address - Street 1:404 WESTWOOD AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-4315
Practice Address - Country:US
Practice Address - Phone:336-884-1400
Practice Address - Fax:336-884-1402
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-23
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC04702255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer