Provider Demographics
NPI:1396021549
Name:MORAN, KATHLEEN ANN (ATC)
Entity Type:Individual
Prefix:MISS
First Name:KATHLEEN
Middle Name:ANN
Last Name:MORAN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:ANN
Other - Last Name:KICKISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:501 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:OCEAN CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08226-3892
Mailing Address - Country:US
Mailing Address - Phone:609-338-3747
Mailing Address - Fax:
Practice Address - Street 1:501 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:OCEAN CITY
Practice Address - State:NJ
Practice Address - Zip Code:08226-3892
Practice Address - Country:US
Practice Address - Phone:609-338-3747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-01
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0050532255A2300X
NJ25MT001645002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer