Provider Demographics
NPI:1881093961
Name:HICKMAN, KATIE (ATC)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:HICKMAN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:MARIE
Other - Last Name:WEINZATL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:7455 NEW RIDGE RD
Mailing Address - Street 2:SUITE L
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-3143
Mailing Address - Country:US
Mailing Address - Phone:410-850-0333
Mailing Address - Fax:
Practice Address - Street 1:7455 NEW RIDGE RD
Practice Address - Street 2:SUITE L
Practice Address - City:HANOVER
Practice Address - State:MD
Practice Address - Zip Code:21076-3143
Practice Address - Country:US
Practice Address - Phone:410-850-0333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1464-392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer