Healthcare Provider Details

I. General information

NPI: 1902640378
Provider Name (Legal Business Name): KATE TODD MS, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2024
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 ENGINEERING WAY
GEORGETOWN KY
40324-0559
US

IV. Provider business mailing address

111 AMERSON ORCHARD RD APT 310
GEORGETOWN KY
40324-8571
US

V. Phone/Fax

Practice location:
  • Phone: 800-331-4331
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberTCA028
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: