MEDICARE: BREANNA I KENDER ATC

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	2255A2300X	Athletic Trainer

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	XXH983760398	OTHER		BLUE CROSS BLUE SHIELD CARD

General Provider Information

NPI Number	:	1558039172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BREANNA I KENDER ATC

Provider Business Mailing Address
First Line	:	63 SCARBOROUGH RD
Second Line	:
City	:	BREWSTER
State	:	MA
Zip	:	02631-2816
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	20 UNIVERSITY DR
Second Line	:
City	:	RINDGE
State	:	NH
Zip	:	03461-5046
Country	:	US
Telephone Number	:	603-899-4357
Fax Number	:

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

Provider Enumeration Date	:	08/30/2021
Last Update Date	:	12/12/2024

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Directions to “ BREANNA I KENDER ATC” Practice Location

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