Healthcare Provider Details

I. General information

NPI: 1801688593
Provider Name (Legal Business Name): HALEY ELIZABETH KUCHINSKY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2025
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 JILL MARIE DR
CARVER MA
02330-1395
US

IV. Provider business mailing address

14 JILL MARIE DR
CARVER MA
02330-1395
US

V. Phone/Fax

Practice location:
  • Phone: 774-223-8112
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2000057238
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: