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General NPI Number Information
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NPI Number | 1326710013
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Entity Type | Individual
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Provider Name | MADISON KITCHEN ATC
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Gender | Female
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Dates
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Enumeration Date | 09/30/2021
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Last Update Date | 09/30/2021
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Provider Practice Location Address
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Address Line | 2500 ENGLISH CREEK AVE STE 1300
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City | EGG HARBOR TOWNSHIP
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State | NJ
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Zip | 08234-5598
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Country | US
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Telephone | 800-321-9999
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Fax |
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Provider Business Mailing Address
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Address Line | 8 ASBURY AVE
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City | OCEAN CITY
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State | NJ
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Zip | 08226-4321
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Country | US
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Telephone | 609-741-5792
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 25MT00294600
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License Number State | NJ
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