Provider Demographics
NPI:1871984781
Name:FICKEN, KASEY (ATC)
Entity type:Individual
Prefix:MS
First Name:KASEY
Middle Name:
Last Name:FICKEN
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 1:4090 GEDDES RD
Mailing Address - Street 2:ATHLETICS
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-2750
Mailing Address - Country:US
Mailing Address - Phone:609-276-5862
Mailing Address - Fax:
Practice Address - Street 1:4090 GEDDES RD
Practice Address - Street 2:ATHLETICS
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-2750
Practice Address - Country:US
Practice Address - Phone:609-276-5862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-13
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18302255A2300X
MI39266182255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer