Individual
MICHAEL KELLY CARTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1811 NORDOFF STREET, NORTHRIDGE, CA 91330-0001
(818) 677-1200
Mailing address
2359 MORENO DR, CAMARILLO, CA 93010-2148
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22
RESPIRATORY, DEVELOPMENTAL, REHABILITATIVE AND RESTORATIVE SERVICE PROVIDERS
CA
Enumeration date
05/22/2019
Last updated
05/22/2019
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