Provider Demographics
NPI:1336524420
Name:STAHL, KATELYNN ANNE (AT)
Entity Type:Individual
Prefix:MISS
First Name:KATELYNN
Middle Name:ANNE
Last Name:STAHL
Suffix:
Gender:F
Credentials:AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:363 RICHLAND AVE
Mailing Address - Street 2:APT. 204
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-3210
Mailing Address - Country:US
Mailing Address - Phone:419-921-6833
Mailing Address - Fax:
Practice Address - Street 1:1 BUCKEYE DR
Practice Address - Street 2:
Practice Address - City:NELSONVILLE
Practice Address - State:OH
Practice Address - Zip Code:45764-9591
Practice Address - Country:US
Practice Address - Phone:740-753-4441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT.0047132255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer