Provider Demographics
NPI:1780198101
Name:DOLAN, KATELYN ELLEN
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:ELLEN
Last Name:DOLAN
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 1:143 CANAL ST APT 9
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-4603
Mailing Address - Country:US
Mailing Address - Phone:845-803-1181
Mailing Address - Fax:
Practice Address - Street 1:412 HALE ST
Practice Address - Street 2:
Practice Address - City:PRIDES CROSSING
Practice Address - State:MA
Practice Address - Zip Code:01965-9800
Practice Address - Country:US
Practice Address - Phone:978-236-3010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA38902255A2300X
AL25092255A2300X, 2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer