Provider Demographics
NPI:1770112864
Name:BLODGETT, KYLIE
Entity type:Individual
Prefix:
First Name:KYLIE
Middle Name:
Last Name:BLODGETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 SWALLOW LN
Mailing Address - Street 2:
Mailing Address - City:DUNSTABLE
Mailing Address - State:MA
Mailing Address - Zip Code:01827-1206
Mailing Address - Country:US
Mailing Address - Phone:978-618-9116
Mailing Address - Fax:
Practice Address - Street 1:12 SWALLOW LN
Practice Address - Street 2:
Practice Address - City:DUNSTABLE
Practice Address - State:MA
Practice Address - Zip Code:01827-1206
Practice Address - Country:US
Practice Address - Phone:978-618-9116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-02
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist