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General NPI Number Information
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NPI Number | 1669993846
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Entity Type | Individual
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Provider Name | KATELYN MCGONIGLE ATC
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Gender | Female
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Dates
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Enumeration Date | 06/28/2017
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Last Update Date | 06/28/2017
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Provider Practice Location Address
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Address Line | 5228 ADOBE RD APT C
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City | TWENTYNINE PALMS
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State | CA
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Zip | 92277-1895
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Country | US
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Telephone | 508-680-6850
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Fax |
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Provider Business Mailing Address
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Address Line | 5228 ADOBE RD APT C
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City | TWENTYNINE PALMS
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State | CA
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Zip | 92277-1895
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Country | US
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Telephone |
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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 | AT6558
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License Number State | TX
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