Healthcare Provider Details

I. General information

NPI: 1760193890
Provider Name (Legal Business Name): KAITLIN VELIE ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2022
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10106 DUPONT CIRCLE DR E
FORT WAYNE IN
46825-1639
US

IV. Provider business mailing address

57415 EMERALD CHASE LN
GOSHEN IN
46528-6278
US

V. Phone/Fax

Practice location:
  • Phone: 260-479-2720
  • Fax:
Mailing address:
  • Phone: 574-361-3298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: