Micum Kyle McIntire, MS, ATC, OTC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

104.0000165 Issued in VT

Practice address

789 Pine St
Burlington, VT 05401-4933

Phone

(802) 264-1052

NPI assigned

Aug 5, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1309910400000",
    "number": "1497764658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 68",
            "city": "LINCOLN",
            "state": "NH",
            "postal_code": "032510068",
            "telephone_number": "603-745-8930",
            "fax_number": "603-745-9898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "789 PINE ST",
            "city": "BURLINGTON",
            "state": "VT",
            "postal_code": "054014933",
            "telephone_number": "802-264-1052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCINTIRE",
        "first_name": "MICUM",
        "middle_name": "KYLE",
        "credential": "MS, ATC, OTC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-05",
        "last_updated": "2011-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246ZS0410X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Technologist",
            "state": "NH",
            "license": "09-0203",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "NH",
            "license": "0363",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "VT",
            "license": "104.0000165",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Haley McGowan, D.O.
• Sandra Boucher McGrath, APRN
• Melissa L McGraw, PHARMD
• Bernadette Rose McGuire, LICSW
• Jessica McGuirl
• Catherine L McIsaac, RD
• Rebecca McKay
• Stacey A McKenna, AA
• Erin Katherine McKenney
• Patricia Logan McKibben, RD, CD

• Athletic Trainer in Burlington, VT
• Providers in Burlington, VT by specialty
• Athletic Trainer in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.