Provider Demographics
NPI:1649660176
Name:MICHAELS, KATLIN M (ATC)
Entity type:Individual
Prefix:
First Name:KATLIN
Middle Name:M
Last Name:MICHAELS
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 1:2115 ALA WAI BLVD APT 1504
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96815-2213
Mailing Address - Country:US
Mailing Address - Phone:570-204-9148
Mailing Address - Fax:
Practice Address - Street 1:917 KALANIANAOLE HWY
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-4600
Practice Address - Country:US
Practice Address - Phone:808-261-0707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-04
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2022255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer