Provider Demographics
NPI:1104296300
Name:PAUL, KATELYN (ATC, LAT)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:PAUL
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 WHATCOAT ST
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30054
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:810 WHATCOAT ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:GA
Practice Address - Zip Code:30054-7207
Practice Address - Country:US
Practice Address - Phone:563-357-7524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-30
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0024732255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer