Provider Demographics
NPI:1356472690
Name:PALMATEER, KIP ALAN (AT,C)
Entity Type:Individual
Prefix:MR
First Name:KIP
Middle Name:ALAN
Last Name:PALMATEER
Suffix:
Gender:M
Credentials:AT,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9202 HAYES HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:COLDEN
Mailing Address - State:NY
Mailing Address - Zip Code:14033-9623
Mailing Address - Country:US
Mailing Address - Phone:716-941-5618
Mailing Address - Fax:
Practice Address - Street 1:94 OLEAN ST
Practice Address - Street 2:
Practice Address - City:EAST AURORA
Practice Address - State:NY
Practice Address - Zip Code:14052-2531
Practice Address - Country:US
Practice Address - Phone:716-828-3700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000529-12255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer