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Individual

AUTUMN KELLY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
STUDENT

Contact information

Practice address
3300 HENRY AVE APT 522, PHILADELPHIA, PA 19129-1160
(908) 202-2605
Mailing address
3300 HENRY AVE APT 522, PHILADELPHIA, PA 19129-1160

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
390200000X
Student in an Organized Health Care Education/Training Program

Other

Enumeration date
08/25/2020
Last updated
08/25/2020
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