Healthcare Provider Details

I. General information

NPI: 1841066933
Provider Name (Legal Business Name): KAILYN LAWLOR LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2023
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 OLD MONTGOMERY HWY APT 4122
TUSCALOOSA AL
35405-5057
US

IV. Provider business mailing address

40 PATRICIA LN
WOLCOTT CT
06716-1045
US

V. Phone/Fax

Practice location:
  • Phone: 203-560-2200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2884
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License Number2884
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: