Individual
TAYLOR MACKENZIE HANES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
63 RIVER CREST DRIVE, PAWCATUCK, CT 06379-2542
(860) 857-9009
Mailing address
63 RIVER CREST DRIVE, PAWCATUCK, CT 06379-2542
(860) 857-9009
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
09/08/2019
Last updated
09/08/2019
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