Provider Demographics
NPI:1063967016
Name:SNIFFEN, KATHERINE (ATC)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:SNIFFEN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:SNIFFEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:24255 PACIFIC COAST HWY
Mailing Address - Street 2:ATHLETIC DEPARTMENT
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90263-3999
Mailing Address - Country:US
Mailing Address - Phone:310-506-4169
Mailing Address - Fax:310-506-4424
Practice Address - Street 1:24255 PACIFIC COAST HWY
Practice Address - Street 2:ATHLETIC DEPARTMENT
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90263-3999
Practice Address - Country:US
Practice Address - Phone:310-506-4169
Practice Address - Fax:310-506-4424
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-19
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer