Provider Demographics
NPI:1780714691
Name:FOX, KATIE JO (MS, ATC, LAT, PES)
Entity type:Individual
Prefix:MS
First Name:KATIE
Middle Name:JO
Last Name:FOX
Suffix:
Gender:F
Credentials:MS, ATC, LAT, PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:448 DOUGLAS RD
Mailing Address - Street 2:
Mailing Address - City:HUMMELSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17036-9449
Mailing Address - Country:US
Mailing Address - Phone:570-660-9253
Mailing Address - Fax:
Practice Address - Street 1:105 PUCILLO DRIVE
Practice Address - Street 2:MILLERSVILLE UNIVERSITY
Practice Address - City:MILLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17551-1350
Practice Address - Country:US
Practice Address - Phone:717-872-3711
Practice Address - Fax:717-871-2470
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0037402255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer