Healthcare Provider Details

I. General information

NPI: 1780702381
Provider Name (Legal Business Name): DEBBY M KITTEL ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5252 AVALON LANE
LOLO MT
59847
US

IV. Provider business mailing address

5252 AVALON LANE
LOLO MT
59847
US

V. Phone/Fax

Practice location:
  • Phone: 406-529-5528
  • Fax:
Mailing address:
  • Phone: 406-529-5528
  • 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: