Provider Demographics
NPI:1285775221
Name:JENKINS, KATHRYN S (ATC)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:S
Last Name:JENKINS
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 1:7706 WASHINGTON PARK DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-3647
Mailing Address - Country:US
Mailing Address - Phone:937-434-2390
Mailing Address - Fax:
Practice Address - Street 1:3490 FAR HILLS AVE
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-2500
Practice Address - Country:US
Practice Address - Phone:937-395-3900
Practice Address - Fax:937-395-3950
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT-0007682255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer