Provider Demographics
NPI:1851512867
Name:WALSH, KATIE M (EDD, ATC, LAT)
Entity Type:Individual
Prefix:MS
First Name:KATIE
Middle Name:M
Last Name:WALSH
Suffix:
Gender:F
Credentials:EDD, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 WARD SPORTS MEDICINE BUILDING
Mailing Address - Street 2:EAST CAROLINA UNIVERSITY
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858
Mailing Address - Country:US
Mailing Address - Phone:252-737-4561
Mailing Address - Fax:252-737-1276
Practice Address - Street 1:245 WARD SPORTS MEDICINE BUILDING
Practice Address - Street 2:EAST CAROLINA UNIVERSITY
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858
Practice Address - Country:US
Practice Address - Phone:252-737-4561
Practice Address - Fax:252-737-1276
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2772255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer