MEDICARE: KAYLA ANN CULLERTON M.ED, M.S, LAT, ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	AT00427	RI
2	2255A2300X	Athletic Trainer	ATL3408	MA
3	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1215302955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA ANN CULLERTON M.ED, M.S, LAT, ATC

Provider Business Mailing Address
First Line	:	44 VOSE ST
Second Line	:
City	:	WOONSOCKET
State	:	RI
Zip	:	02895-5234
Country	:	US
Telephone Number	:	401-808-0804
Fax Number	:

Provider Business Practice Location Address
First Line	:	320 WASHINGTON ST
Second Line	:
City	:	NORTH EASTON
State	:	MA
Zip	:	02357-5234
Country	:	US
Telephone Number	:	508-565-1592
Fax Number	:	508-565-1988

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2015
Last Update Date	:	01/26/2024

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