Provider Demographics
NPI:1437884699
Name:NIEMER, KAITLYN ROSE (ATC)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:ROSE
Last Name:NIEMER
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 1:2859 N BOULDER DR APT 21
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-3152
Mailing Address - Country:US
Mailing Address - Phone:630-536-6263
Mailing Address - Fax:
Practice Address - Street 1:1845 FAIRMOUNT ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67260-9700
Practice Address - Country:US
Practice Address - Phone:630-536-6263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer