Provider Demographics
NPI:1518223700
Name:HICKEY, KATHRYN LISA (ATC)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:LISA
Last Name:HICKEY
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 1:944 LANDON AVE
Mailing Address - Street 2:
Mailing Address - City:WINTHROP HARBOR
Mailing Address - State:IL
Mailing Address - Zip Code:60096-1732
Mailing Address - Country:US
Mailing Address - Phone:847-501-0620
Mailing Address - Fax:
Practice Address - Street 1:944 LANDON AVE
Practice Address - Street 2:
Practice Address - City:WINTHROP HARBOR
Practice Address - State:IL
Practice Address - Zip Code:60096-1732
Practice Address - Country:US
Practice Address - Phone:847-501-0620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-02
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096.0014432255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer