Provider Demographics
NPI:1366959538
Name:RICKLEFS, KAITLIN MARIE (MS, LAT, ATC)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:MARIE
Last Name:RICKLEFS
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5000
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-7000
Mailing Address - Country:US
Mailing Address - Phone:515-835-7085
Mailing Address - Fax:
Practice Address - Street 1:400 ATLANTIC CHRISTIAN COL DR NE
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-2505
Practice Address - Country:US
Practice Address - Phone:252-399-6363
Practice Address - Fax:252-399-6516
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC32252255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer