Healthcare Provider Details

I. General information

NPI: 1679019558
Provider Name (Legal Business Name): KATHERINE JOAN HILBERT ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2017
Last Update Date: 01/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 PAGE AVE
JACKSON MI
49201-2418
US

IV. Provider business mailing address

36 HYDE RD
CLARKLAKE MI
49234-9652
US

V. Phone/Fax

Practice location:
  • Phone: 517-783-6670
  • Fax:
Mailing address:
  • Phone: 248-515-7815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2601001180
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: