Provider Demographics
NPI:1952813347
Name:ESTEPP, MARY KATHLEEN (ATC/LAT)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:KATHLEEN
Last Name:ESTEPP
Suffix:
Gender:F
Credentials:ATC/LAT
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:KATHLEEN
Other - Last Name:MCCAULEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC/LAT
Mailing Address - Street 1:143 W THOMPSON ST
Mailing Address - Street 2:
Mailing Address - City:RENSSELAER
Mailing Address - State:IN
Mailing Address - Zip Code:47978-3160
Mailing Address - Country:US
Mailing Address - Phone:574-457-9238
Mailing Address - Fax:
Practice Address - Street 1:143 W THOMPSON ST
Practice Address - Street 2:
Practice Address - City:RENSSELAER
Practice Address - State:IN
Practice Address - Zip Code:47978-3160
Practice Address - Country:US
Practice Address - Phone:574-457-9238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-25
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36002538A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer