Individual
MR. KYLE J PECKHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
10 EDGEWOOD DR, ESSEX JUNCTION, VT 05452-3073
(802) 734-6364
Mailing address
10 EDGEWOOD DR, ESSEX JUNCTION, VT 05452-3073
(802) 734-6364
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/23/2015
Last updated
12/10/2015
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