Provider Demographics
NPI:1639661440
Name:HICKERSON, KATLIN M (DPT)
Entity type:Individual
Prefix:
First Name:KATLIN
Middle Name:M
Last Name:HICKERSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KATLIN
Other - Middle Name:M
Other - Last Name:BATCHELLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2122 YORK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1925
Mailing Address - Country:US
Mailing Address - Phone:630-575-1980
Mailing Address - Fax:
Practice Address - Street 1:333 E GREGORY BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-1123
Practice Address - Country:US
Practice Address - Phone:816-313-8899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-06
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-05858225100000X
MO2018034739225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist