Provider Demographics
NPI:1518565985
Name:HOLLOWELL, KATHIE LANETTE (MSE, LAT, ATC, CPTA)
Entity Type:Individual
Prefix:
First Name:KATHIE
Middle Name:LANETTE
Last Name:HOLLOWELL
Suffix:
Gender:F
Credentials:MSE, LAT, ATC, CPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:1845 FAIRMOUNT
Mailing Address - Street 2:CAMPUS BOX 18
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67260-0001
Mailing Address - Country:US
Mailing Address - Phone:316-619-1856
Mailing Address - Fax:316-978-3177
Practice Address - Street 1:1845 FAIRMOUNT ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67260-0001
Practice Address - Country:US
Practice Address - Phone:316-978-5574
Practice Address - Fax:316-978-3177
Is Sole Proprietor?:No
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-01631225200000X
KS24-004822255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant