Provider Demographics
NPI:1154395861
Name:KIRKLAND, MARY KATHLEEN (MS, ATC, LAT, CSCS)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:KATHLEEN
Last Name:KIRKLAND
Suffix:
Gender:F
Credentials:MS, ATC, LAT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:THE BIONETICS CORPORATION
Mailing Address - Street 2:MAILCODE BIO-8
Mailing Address - City:KENNEDY SPACE CENTER
Mailing Address - State:FL
Mailing Address - Zip Code:32899-0001
Mailing Address - Country:US
Mailing Address - Phone:321-867-7497
Mailing Address - Fax:321-867-1144
Practice Address - Street 1:THE BIONETICS CORPORATION
Practice Address - Street 2:MAILCODE BIO-8
Practice Address - City:KENNEDY SPACE CENTER
Practice Address - State:FL
Practice Address - Zip Code:32899-0001
Practice Address - Country:US
Practice Address - Phone:321-867-7497
Practice Address - Fax:321-867-1144
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL482255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer