Individual
KELLY PAULS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1793 E WATERFORD CT, APARTMENT 224, AKRON, OH 44313-8367
(732) 379-1680
Mailing address
6117 VEVEY LN, FORT MILL, SC 29707-8632
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
39
ATHLETIC TRAINING
SC
Enumeration date
08/29/2014
Last updated
04/18/2017
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