Individual
MR. KELLY SCOTT WITHEM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC, LAT
Contact information
Practice address
1606 N 7TH ST, TERRE HAUTE, IN 47804-2706
(812) 238-7000
Mailing address
150 N ROSENBERGER AVE, EVANSVILLE, IN 47712-6503
(812) 491-3856
(812) 759-1586
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36000257A
IN
Other
Enumeration date
02/21/2014
Last updated
02/21/2014
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