Provider Demographics
NPI:1912948639
Name:KICHLINE, JAIME R (ATC)
Entity Type:Individual
Prefix:MRS
First Name:JAIME
Middle Name:R
Last Name:KICHLINE
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 1:329 STONEHEDGE LN
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-7004
Mailing Address - Country:US
Mailing Address - Phone:717-691-5362
Mailing Address - Fax:
Practice Address - Street 1:329 STONEHEDGE LN
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055-7004
Practice Address - Country:US
Practice Address - Phone:717-691-5362
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART002285A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer