Healthcare Provider Details

I. General information

NPI: 1700042728
Provider Name (Legal Business Name): KRISTEN MARIE TOBIN MS, ATC/L, EMT-B
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2008
Last Update Date: 07/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 ALUMNI DR
CANAAN NH
03741-7210
US

IV. Provider business mailing address

62 ALUMNI DR
CANAAN NH
03741-7210
US

V. Phone/Fax

Practice location:
  • Phone: 860-917-3553
  • Fax: 603-523-3742
Mailing address:
  • Phone: 860-917-3553
  • Fax: 603-523-3742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0377
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: