Provider Demographics
NPI:1740749407
Name:THOMPSON, KAITLYN (ATC)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:THOMPSON
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 1:840 E CITRUS AVE
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-5325
Mailing Address - Country:US
Mailing Address - Phone:909-307-5500
Mailing Address - Fax:
Practice Address - Street 1:840 E CITRUS AVE
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-5325
Practice Address - Country:US
Practice Address - Phone:909-307-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-13
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2000033581OtherNATIONAL ATHLETIC TRAINING ASSOCIATION