Provider Demographics
NPI:1962538041
Name:BOYD, KATHLEEN A (MS ATC LAT)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A
Last Name:BOYD
Suffix:
Gender:F
Credentials:MS ATC LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 FEDERAL ST
Mailing Address - Street 2:
Mailing Address - City:BELCHERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:01007-9736
Mailing Address - Country:US
Mailing Address - Phone:413-253-9610
Mailing Address - Fax:
Practice Address - Street 1:131 COMMONWEALTH AVE
Practice Address - Street 2:ROOM 9 BOYDEN
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01003-9253
Practice Address - Country:US
Practice Address - Phone:413-545-4093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3362255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA336OtherATHLETIC TRAINER