Basic Information
| Provider Information | |||||||||
| NPI: | 1871110411 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DOLPHIN | ||||||||
| FirstName: | KAYLEIGH | ||||||||
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| Credential: | MS, LAT, ATC, CES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 166 SPRINGBROOK AVE STE 201 | ||||||||
| Address2: | |||||||||
| City: | CLAYTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275208520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195358461 | ||||||||
| FaxNumber: | 9195358459 | ||||||||
| Practice Location | |||||||||
| Address1: | 166 SPRINGBROOK AVE STE 201 | ||||||||
| Address2: | |||||||||
| City: | CLAYTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275208520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195358461 | ||||||||
| FaxNumber: | 9195358459 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2020 | ||||||||
| LastUpdateDate: | 03/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | LAT-2939 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.