Basic Information
| Provider Information | |||||||||
| NPI: | 1578005773 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KERR | ||||||||
| FirstName: | BRANDON | ||||||||
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| Credential: | ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 53 ICE HOUSE LN | ||||||||
| Address2: | |||||||||
| City: | MARSHFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020504248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172810635 | ||||||||
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| Practice Location | |||||||||
| Address1: | 250 E MAIN ST UNIT 7 | ||||||||
| Address2: | |||||||||
| City: | NORTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027662436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5082855533 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2016 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | 2918 | MA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.