Provider Demographics
NPI:1528296126
Name:CHASE, KRISTIN I (ATC)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:I
Last Name:CHASE
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 1:811 112TH ST SW APT H102
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-7849
Mailing Address - Country:US
Mailing Address - Phone:425-293-2608
Mailing Address - Fax:
Practice Address - Street 1:811 112TH ST SW APT H102
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-7849
Practice Address - Country:US
Practice Address - Phone:425-293-2608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND349-08/092255A2300X
MN21542255A2300X
WA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer