Individual
KELLY AMANDA GODDARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
201 NICHOLS TER, STRATFORD, CT 06614-3959
(203) 377-1752
Mailing address
201 NICHOLS TER, STRATFORD, CT 06614-3959
(203) 377-1752
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1851
CT
390200000X
Student in an Organized Health Care Education/Training Program
—
CT
Other
Enumeration date
10/29/2021
Last updated
06/02/2024
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