Provider Demographics
NPI:1992366280
Name:BARRERA, KATELYN MARIA (MS, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:MARIA
Last Name:BARRERA
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2314 KALISTE SALOOM RD APT 801
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6834
Mailing Address - Country:US
Mailing Address - Phone:512-289-0315
Mailing Address - Fax:
Practice Address - Street 1:2314 KALISTE SALOOM RD APT 801
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6834
Practice Address - Country:US
Practice Address - Phone:512-289-0315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-26
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
SCAT030492255A2300X
LA33117572255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer