Provider Demographics
NPI:1205869500
Name:KELLINGTON, DENNIS WILLIAM (MA, ATC)
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:WILLIAM
Last Name:KELLINGTON
Suffix:
Gender:M
Credentials:MA, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MANLEY FIELD HOUSE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13244-5020
Mailing Address - Country:US
Mailing Address - Phone:315-443-4775
Mailing Address - Fax:315-443-5057
Practice Address - Street 1:MANLEY FIELD HOUSE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13244-5020
Practice Address - Country:US
Practice Address - Phone:315-443-4775
Practice Address - Fax:315-443-5057
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001364-1225500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY001364-1OtherATHLETIC TRAINER LICENSE