Individual
KENNETH S MACKILLOP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATS
Contact information
Practice address
3421 LAKE RD, CHARLOTTE, VT 05445-8243
(802) 999-6225
Mailing address
3421 LAKE RD, CHARLOTTE, VT 05445-8243
(802) 999-6225
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
09/05/2019
Last updated
09/05/2019
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