Provider Demographics
NPI:1639661440
Name:HICKERSON, KATLIN M (DPT)
Entity Type:Individual
Prefix:
First Name:KATLIN
Middle Name:M
Last Name:HICKERSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KATLIN
Other - Middle Name:M
Other - Last Name:BATCHELLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:600 OAKMONT LN STE 600C
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5548
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6911 TOMAHAWK RD
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-2618
Practice Address - Country:US
Practice Address - Phone:913-871-6291
Practice Address - Fax:913-871-7633
Is Sole Proprietor?:No
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist