Individual
KELLY MCCULLOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
954 N COUNTY ROAD 250 W, BRAZIL, IN 47834-7495
(812) 243-5925
Mailing address
954 N COUNTY ROAD 250 W, BRAZIL, IN 47834-7495
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
01/30/2015
Last updated
01/30/2015
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