Provider Demographics
NPI:1215302955
Name:CULLERTON, KAYLA ANN (MED, MS, LAT, ATC)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:ANN
Last Name:CULLERTON
Suffix:
Gender:F
Credentials:MED, MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 VOSE ST
Mailing Address - Street 2:
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-5234
Mailing Address - Country:US
Mailing Address - Phone:401-808-0804
Mailing Address - Fax:
Practice Address - Street 1:320 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NORTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02357-5234
Practice Address - Country:US
Practice Address - Phone:508-565-1592
Practice Address - Fax:508-565-1988
Is Sole Proprietor?:No
Enumeration Date:2015-12-07
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAT004272255A2300X
MAATL34082255A2300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program