Provider Demographics
NPI:1588095947
Name:DEZENZO, KATELYN (ATC)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:DEZENZO
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:
Other - Last Name:KINNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:65 N HARVARD ST
Mailing Address - Street 2:DILLON FIELD HOUSE
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02163-1010
Mailing Address - Country:US
Mailing Address - Phone:617-495-2200
Mailing Address - Fax:
Practice Address - Street 1:BATES COLLEGE
Practice Address - Street 2:130 CENTRAL AVENUE
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240
Practice Address - Country:US
Practice Address - Phone:207-786-6470
Practice Address - Fax:207-755-5839
Is Sole Proprietor?:No
Enumeration Date:2013-12-10
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA27632255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer