Provider Demographics
NPI:1982235529
Name:FREDERICK, KAITLYN YVONNE (ATC, NR-EMT, OPE-C)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:YVONNE
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:ATC, NR-EMT, OPE-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 ROSE ST
Mailing Address - Street 2:
Mailing Address - City:CARLETON
Mailing Address - State:MI
Mailing Address - Zip Code:48117-9510
Mailing Address - Country:US
Mailing Address - Phone:734-624-5370
Mailing Address - Fax:
Practice Address - Street 1:300 E COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-3742
Practice Address - Country:US
Practice Address - Phone:843-383-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-02
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program