Healthcare Provider Details

I. General information

NPI: 1508827726
Provider Name (Legal Business Name): RACHEL CLAIRE KIDD ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 GRANITE ST
MANCHESTER NH
03102-4000
US

IV. Provider business mailing address

207 AGNES ST APT 310
MANCHESTER NH
03102-3357
US

V. Phone/Fax

Practice location:
  • Phone: 603-626-0760
  • Fax:
Mailing address:
  • Phone: 603-232-0861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number314
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: