Provider Demographics
NPI:1922077213
Name:HOLLOMON, KATHY W (LAT, ATC)
Entity Type:Individual
Prefix:MS
First Name:KATHY
Middle Name:W
Last Name:HOLLOMON
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 1:3020 WHITE CLOUD CIR
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-4065
Mailing Address - Country:US
Mailing Address - Phone:919-306-9977
Mailing Address - Fax:
Practice Address - Street 1:123 MIDDLE CREEK PARK AVE
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27539-7983
Practice Address - Country:US
Practice Address - Phone:919-661-5474
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC04422255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer