Provider Demographics
NPI:1598202525
Name:GRIFFITH, KAITLYN (MS, ATC)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 1/2 AMHERST ST
Mailing Address - Street 2:APT. B
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-4154
Mailing Address - Country:US
Mailing Address - Phone:540-922-5664
Mailing Address - Fax:
Practice Address - Street 1:219 1/2 AMHERST ST
Practice Address - Street 2:APT. B
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-4154
Practice Address - Country:US
Practice Address - Phone:540-922-5664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-29
Last Update Date:2017-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAT0014892255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer