Provider Demographics
NPI:1417629767
Name:REECE, KAITLIN (MS, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:REECE
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 674
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:NE
Mailing Address - Zip Code:68779-0674
Mailing Address - Country:US
Mailing Address - Phone:402-376-4711
Mailing Address - Fax:
Practice Address - Street 1:1007 KINGWOOD ST
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:NE
Practice Address - Zip Code:68779-2267
Practice Address - Country:US
Practice Address - Phone:402-439-2250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer