Provider Demographics
NPI:1336795475
Name:WALSTON, KAYCEE MONTANA (ATC)
Entity Type:Individual
Prefix:MISS
First Name:KAYCEE
Middle Name:MONTANA
Last Name:WALSTON
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3867 CRATER CT
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-2201
Mailing Address - Country:US
Mailing Address - Phone:707-227-6620
Mailing Address - Fax:
Practice Address - Street 1:3867 CRATER CT
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-2201
Practice Address - Country:US
Practice Address - Phone:707-227-6620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer