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NPI Code Detail

MEDICARE: KATIE WALSH MAED, LAT, ATC

MEDICARE: KATIE WALSH MAED, LAT, ATC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer

General Provider Information

NPI Number : 1033667928
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATIE WALSH MAED, LAT, ATC
Provider Business Mailing Address
First Line : 106 W SEEBOTH ST UNIT 306
Second Line :
City : MILWAUKEE
State : WI
Zip : 53204-4322
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3409 N DOWNER AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53211-2934
Country : US
Telephone Number : 847-682-8599
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2016
Last Update Date : 01/29/2024

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