Healthcare Provider Details

I. General information

NPI: 1912360207
Provider Name (Legal Business Name): KATRINA JOLENE MARSHALL ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2016
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 S LOCUST ST # 313
GREENCASTLE IN
46135-1736
US

IV. Provider business mailing address

1112 DELWOOD DR
MOORESVILLE IN
46158-1115
US

V. Phone/Fax

Practice location:
  • Phone: 765-318-9578
  • Fax:
Mailing address:
  • Phone: 765-318-9578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number3600319A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: