Individual
KELLI BOLTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, ATC
Contact information
Practice address
527 MONTGOMERY ST, CUSTER, SD 57730-1124
(605) 840-4794
Mailing address
639 NORTHERN LIGHTS BLVD APT 3304, BOX ELDER, SD 57719-6399
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2000017784
SD
Other
Enumeration date
07/25/2017
Last updated
07/25/2017
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