Individual
KELLY MARIE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1472 MOBLEY CT, FREDERICK, MD 21701-9113
(240) 578-2329
Mailing address
1472 MOBLEY CT, FREDERICK, MD 21701-9113
(240) 578-2329
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/12/2019
Last updated
03/12/2019
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