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General NPI Number Information
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NPI Number | 1780198101
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Entity Type | Individual
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Provider Name | KATELYN ELLEN DOLAN
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Gender | Female
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Dates
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Enumeration Date | 11/21/2017
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Last Update Date | 06/21/2024
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Provider Practice Location Address
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Address Line | 412 HALE ST
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City | PRIDES CROSSING
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State | MA
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Zip | 01965-9800
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Country | US
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Telephone | 978-236-3010
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Fax |
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Provider Business Mailing Address
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Address Line | 143 CANAL ST APT 9
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City | SALEM
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State | MA
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Zip | 01970-4603
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Country | US
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Telephone | 845-803-1181
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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 | 3890
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2509
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License Number State | AL
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