Provider Demographics
NPI:1568933992
Name:KARPOFF, KATELYN MARIE (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:MARIE
Last Name:KARPOFF
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1504 SEVEN PINES RD APT H
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-5797
Mailing Address - Country:US
Mailing Address - Phone:440-477-9784
Mailing Address - Fax:
Practice Address - Street 1:447 E COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62650-2510
Practice Address - Country:US
Practice Address - Phone:440-477-9784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-11
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer