Provider Demographics
NPI:1780185207
Name:WARD, KATELYN MARIE (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:MARIE
Last Name:WARD
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 1:7751 E CAMELBACK RD APT 203
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-2209
Mailing Address - Country:US
Mailing Address - Phone:908-616-3510
Mailing Address - Fax:
Practice Address - Street 1:20401 N 73RD ST STE 155
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-4149
Practice Address - Country:US
Practice Address - Phone:800-483-0726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZATR-0092092255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer