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Individual
KYLE DOLAN
Active
Individual
KYLE DOLAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1628
SC
2255A2300X
Athletic Trainer
2000015215
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1628
DHEC STATE CERTIFICATION
SC
01
—
2000015215
BOC LICENSURE
MA
Enumeration date
03/04/2016
Last updated
03/04/2016
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