Provider Demographics
NPI:1558088567
Name:WIKING, KATHERINE (ATC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:WIKING
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 1:65 HOUGHTON ST APT 1
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:MA
Mailing Address - Zip Code:01749-2514
Mailing Address - Country:US
Mailing Address - Phone:516-382-0714
Mailing Address - Fax:
Practice Address - Street 1:65 HOUGHTON ST APT 1
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:MA
Practice Address - Zip Code:01749-2514
Practice Address - Country:US
Practice Address - Phone:516-382-0714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA32572255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2000010108OtherN/A