Basic Information
| Provider Information | |||||||||
| NPI: | 1326710013 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KITCHEN | ||||||||
| FirstName: | MADISON | ||||||||
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| Credential: | ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8 ASBURY AVE | ||||||||
| Address2: | |||||||||
| City: | OCEAN CITY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082264321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6097415792 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2500 ENGLISH CREEK AVE STE 1300 | ||||||||
| Address2: | |||||||||
| City: | EGG HARBOR TOWNSHIP | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082345598 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003219999 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2021 | ||||||||
| LastUpdateDate: | 09/30/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | 25MT00294600 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.