MEDICARE: MRS. KRISTIN LYNN DALTON M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	170300000X	Genetic Counselor (M.S.)

General Provider Information

NPI Number	:	1073597456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTIN LYNN DALTON M.S.

Provider Business Mailing Address
First Line	:	90 HALL RD
Second Line	:	APT. 30
City	:	STURBRIDGE
State	:	MA
Zip	:	01566-1550
Country	:	US
Telephone Number	:	508-347-2943
Fax Number	:

Provider Business Practice Location Address
First Line	:	794 CHESTNUT ST
Second Line	:
City	:	SPRINGFIELD
State	:	MA
Zip	:	01199-0001
Country	:	US
Telephone Number	:	413-794-0881
Fax Number	:	413-794-1666

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	07/08/2007

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