Individual
KELLY SUPLIT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
20770 HILLIARD BLVD, ROCKY RIVER, OH 44116-3309
(330) 808-4073
Mailing address
2460 18TH ST, CUYAHOGA FALLS, OH 44223-2010
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT005309
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AT005309
OHIO OTPTAT BOARD
OH
Enumeration date
11/15/2016
Last updated
01/07/2019
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