Individual
TARIQ KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1 WILLARD AVE, HOUGHTON, NY 14744-8732
(585) 567-9563
Mailing address
1 WILLARD AVE, HOUGHTON, NY 14744-8732
(585) 567-9563
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
003316-1
NY
Other
Enumeration date
03/13/2017
Last updated
03/13/2017
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