Individual
KELLY LYNN BENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
610 STILLWELL AVE, TILLAMOOK, OR 97141-3752
(503) 842-9622
(503) 815-2643
Mailing address
610 STILLWELL AVE, TILLAMOOK, OR 97141-3752
(503) 842-9622
(503) 815-2643
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
N485722
CA
Other
Enumeration date
05/03/2018
Last updated
05/03/2018
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