Active NPI
Kallie Daniele Van Coppenolle
- Athletic Trainer
- Streetsboro, OH
National Provider Identifier
1174080352
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- Practice address
- 339 Opal CT
Streetsboro, OH 44241-4147 - Phone
- (330) 780-1369
- NPI assigned
- Feb 25, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | Primary |
Addresses
Primary practice location
339 Opal CT
Streetsboro, OH 44241-4147
Mailing address
339 Opal CT
Streetsboro, OH 44241-4147
Phone (330) 780-1369
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1551052800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757548800000",
"number": "1174080352",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "339 OPAL CT",
"city": "STREETSBORO",
"state": "OH",
"postal_code": "442414147",
"telephone_number": "330-780-1369"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "339 OPAL CT",
"city": "STREETSBORO",
"state": "OH",
"postal_code": "442414147",
"telephone_number": "330-780-1369"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAN COPPENOLLE",
"first_name": "KALLIE",
"middle_name": "DANIELE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-02-25",
"last_updated": "2025-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Streetsboro, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.