MEDICARE: KAITLIN DANIELLE KROLL ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1093201915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLIN DANIELLE KROLL ATC

Provider Business Mailing Address
First Line	:	1062 VALLEY DR APT 6
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57703-4700
Country	:	US
Telephone Number	:	406-465-9243
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 E SAINT JOSEPH ST
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-3901
Country	:	US
Telephone Number	:	406-465-9243
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2018
Last Update Date	:	10/24/2022

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