Provider Demographics
NPI:1902438690
Name:GITCHEL, KRISTEN (ATC, LAT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:
Last Name:GITCHEL
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:MISS
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:TAMMANY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:904 7TH ST
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-5310
Mailing Address - Country:US
Mailing Address - Phone:307-851-1967
Mailing Address - Fax:
Practice Address - Street 1:2500 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-5802
Practice Address - Country:US
Practice Address - Phone:307-382-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1202255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer