Individual
MICUM KYLE MCINTIRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, ATC, OTC
Contact information
Practice address
789 PINE ST, BURLINGTON, VT 05401-4933
(802) 264-1052
Mailing address
PO BOX 68, LINCOLN, NH 03251-0068
(603) 745-8930
(603) 745-9898
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
0363
NH
2255A2300X
Athletic Trainer
Primary
104.0000165
VT
246ZS0410X
Surgical Technologist
09-0203
NH
Other
Enumeration date
08/05/2006
Last updated
07/06/2011
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