Provider Demographics
NPI:1770065336
Name:KITTLESON, KATHRYN (ATC, LAT, MA)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:KITTLESON
Suffix:
Gender:F
Credentials:ATC, LAT, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2635 N 63RD ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68507-2499
Mailing Address - Country:US
Mailing Address - Phone:402-436-1337
Mailing Address - Fax:402-436-1353
Practice Address - Street 1:2635 N 63RD ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68507-2422
Practice Address - Country:US
Practice Address - Phone:402-436-1337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6972255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer