Provider Demographics
NPI:1972994465
Name:HERINGTON, KATIE MAE (ATC)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:MAE
Last Name:HERINGTON
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 1:1 DOT WAY
Mailing Address - Street 2:
Mailing Address - City:MOUNT STERLING
Mailing Address - State:IL
Mailing Address - Zip Code:62353-1664
Mailing Address - Country:US
Mailing Address - Phone:217-773-4411
Mailing Address - Fax:217-773-4903
Practice Address - Street 1:1 DOT WAY
Practice Address - Street 2:
Practice Address - City:MOUNT STERLING
Practice Address - State:IL
Practice Address - Zip Code:62353-1664
Practice Address - Country:US
Practice Address - Phone:217-773-4411
Practice Address - Fax:217-773-4903
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-05
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096.0035992255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer