Provider Demographics
NPI:1912366378
Name:STILES, KATIE (ATC, LMT)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:STILES
Suffix:
Gender:F
Credentials:ATC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41490 BROWN RD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:OH
Mailing Address - Zip Code:43719-9701
Mailing Address - Country:US
Mailing Address - Phone:740-310-6683
Mailing Address - Fax:
Practice Address - Street 1:49383 SHEBA RD
Practice Address - Street 2:
Practice Address - City:JACOBSBURG
Practice Address - State:OH
Practice Address - Zip Code:43933-9604
Practice Address - Country:US
Practice Address - Phone:740-310-6683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-15
Last Update Date:2020-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT.0047072255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer