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Individual

KAYLA MACINNIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MS, ATC, EMT-B

Contact information

Practice address
73 SOUTHERN BLVD, DANBURY, CT 06810
(203) 744-1510
Mailing address
73 SOUTHERN BLVD, DANBURY, CT 06810-7994
(203) 744-1510
(203) 744-1275

Taxonomy

Speciality
Code
Description
License number
State
146N00000X
Basic Emergency Medical Technician
22885
CT
2255A2300X
Athletic Trainer
Primary
1084
CT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2000018481
NATIONAL ATHLETIC TRAINERS ASSOCIATION - BOARD OF CERTIFICATION
CT
01
22885
EMT-B
CT
Enumeration date
03/05/2015
Last updated
02/24/2019
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