Provider Demographics
NPI:1841785169
Name:ASHTON, SIDNEY KATELYN (LAT, ATC)
Entity type:Individual
Prefix:
First Name:SIDNEY
Middle Name:KATELYN
Last Name:ASHTON
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 179
Mailing Address - Street 2:
Mailing Address - City:ARCHER CITY
Mailing Address - State:TX
Mailing Address - Zip Code:76351-0179
Mailing Address - Country:US
Mailing Address - Phone:940-613-2096
Mailing Address - Fax:
Practice Address - Street 1:1 W MEDICAL CT
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76310-1767
Practice Address - Country:US
Practice Address - Phone:940-692-4688
Practice Address - Fax:940-692-8388
Is Sole Proprietor?:No
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65082255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer