Individual
KELLI HANSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAT, ATC
Contact information
Practice address
901 ADAMS ST, AFTON, WY 83110-9621
(307) 885-5800
Mailing address
PO BOX 1482, AFTON, WY 83110-1482
(208) 850-9039
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
115
WY
Other
Enumeration date
05/07/2019
Last updated
05/07/2019
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