Provider Demographics
NPI:1316651060
Name:POWELL, KALYN (ATC, LAT)
Entity type:Individual
Prefix:
First Name:KALYN
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 105
Mailing Address - Street 2:
Mailing Address - City:STUYVESANT FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12174-0105
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:45 CROWN CT
Practice Address - Street 2:
Practice Address - City:STUYVESANT
Practice Address - State:NY
Practice Address - Zip Code:12173-1606
Practice Address - Country:US
Practice Address - Phone:518-506-0890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-09
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer