Provider Demographics
NPI:1467822338
Name:HILDEBRAND, KACEY (ATC)
Entity Type:Individual
Prefix:
First Name:KACEY
Middle Name:
Last Name:HILDEBRAND
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 1:2828 1ST AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25702-1236
Mailing Address - Country:US
Mailing Address - Phone:304-525-2690
Mailing Address - Fax:304-529-6880
Practice Address - Street 1:2828 1ST AVE STE 400
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25702-1236
Practice Address - Country:US
Practice Address - Phone:304-525-2690
Practice Address - Fax:304-529-6880
Is Sole Proprietor?:No
Enumeration Date:2015-10-04
Last Update Date:2015-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAT0012532255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0010681000Medicaid
OH352265Medicaid
WVSC9270051Medicare PIN
OHSC9270053Medicare PIN