Provider Demographics
NPI:1609290055
Name:MCCAULEY, KENDALL (ATC)
Entity Type:Individual
Prefix:
First Name:KENDALL
Middle Name:
Last Name:MCCAULEY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3719 88TH ST NE
Mailing Address - Street 2:STE A
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-7228
Mailing Address - Country:US
Mailing Address - Phone:360-659-9621
Mailing Address - Fax:
Practice Address - Street 1:3719 88TH ST NE
Practice Address - Street 2:STE A
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-7228
Practice Address - Country:US
Practice Address - Phone:360-659-9621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAT600476852255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer