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General NPI Number Information
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NPI Number | 1881093961
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Entity Type | Individual
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Provider Name | KATIE HICKMAN ATC
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Gender | Female
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Dates
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Enumeration Date | 08/14/2014
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Last Update Date | 05/28/2015
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Provider Practice Location Address
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Address Line | 7455 NEW RIDGE RD SUITE L
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City | HANOVER
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State | MD
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Zip | 21076-3143
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Country | US
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Telephone | 410-850-0333
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Fax |
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Provider Business Mailing Address
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Address Line | 7455 NEW RIDGE RD SUITE L
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City | HANOVER
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State | MD
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Zip | 21076-3143
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Country | US
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Telephone | 410-850-0333
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 1464-39
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License Number State | WI
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