Provider Demographics
NPI:1992083059
Name:MCDONALD, KEVIN THOMAS (ATC)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:THOMAS
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 LANTANA DR
Mailing Address - Street 2:
Mailing Address - City:HOCKESSIN
Mailing Address - State:DE
Mailing Address - Zip Code:19707-8805
Mailing Address - Country:US
Mailing Address - Phone:302-239-2800
Mailing Address - Fax:302-239-7500
Practice Address - Street 1:216 LANTANA DR
Practice Address - Street 2:
Practice Address - City:HOCKESSIN
Practice Address - State:DE
Practice Address - Zip Code:19707-8805
Practice Address - Country:US
Practice Address - Phone:302-239-2800
Practice Address - Fax:302-239-7500
Is Sole Proprietor?:No
Enumeration Date:2011-07-23
Last Update Date:2011-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ3-00003942255A2300X
PART001417A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer