Provider Demographics
NPI:1558738377
Name:EVANS, CATHRYN NICOLE (ATC)
Entity Type:Individual
Prefix:
First Name:CATHRYN
Middle Name:NICOLE
Last Name:EVANS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:CATHRYN
Other - Middle Name:NICOLE
Other - Last Name:HALLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:568 CUTTY CT
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:MI
Mailing Address - Zip Code:49036-8229
Mailing Address - Country:US
Mailing Address - Phone:810-728-1644
Mailing Address - Fax:
Practice Address - Street 1:568 CUTTY CT
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-8229
Practice Address - Country:US
Practice Address - Phone:810-728-1644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2255A2300X
2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer