Provider Demographics
NPI:1457512139
Name:WILKEY, KRISTEN M (ATC, OTC)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:M
Last Name:WILKEY
Suffix:
Gender:F
Credentials:ATC, OTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 OLDE TOWNE PKWY STE 430
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-4424
Mailing Address - Country:US
Mailing Address - Phone:770-321-1001
Mailing Address - Fax:770-321-8290
Practice Address - Street 1:4800 OLDE TOWNE PKWY STE 430
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-4424
Practice Address - Country:US
Practice Address - Phone:770-321-1001
Practice Address - Fax:770-321-8290
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0014072255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer