Provider Demographics
NPI:1144357237
Name:DORNBOS, KATE MARIE (ATC)
Entity type:Individual
Prefix:
First Name:KATE
Middle Name:MARIE
Last Name:DORNBOS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4431 DOVER HILLS DR APT 106
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-2720
Mailing Address - Country:US
Mailing Address - Phone:616-283-6254
Mailing Address - Fax:
Practice Address - Street 1:4431 DOVER HILLS DR APT 106
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-2720
Practice Address - Country:US
Practice Address - Phone:616-283-6254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer