Provider Demographics
NPI:1912362153
Name:HITCHCOCK, KAYLEIGH (MAT, AT, ATC)
Entity Type:Individual
Prefix:MS
First Name:KAYLEIGH
Middle Name:
Last Name:HITCHCOCK
Suffix:
Gender:F
Credentials:MAT, AT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 N HYATT ST
Mailing Address - Street 2:
Mailing Address - City:TIPP CITY
Mailing Address - State:OH
Mailing Address - Zip Code:45371-1433
Mailing Address - Country:US
Mailing Address - Phone:937-667-2614
Mailing Address - Fax:937-667-4038
Practice Address - Street 1:450 N HYATT ST
Practice Address - Street 2:
Practice Address - City:TIPP CITY
Practice Address - State:OH
Practice Address - Zip Code:45371-1433
Practice Address - Country:US
Practice Address - Phone:937-667-2614
Practice Address - Fax:937-667-4038
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-15
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT.0042812255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer