Individual
BENJAMIN KENNETH KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LAT, ATC, ITAT
Contact information
Practice address
86 PRIDE PKWY, ACCIDENT, MD 21520-2006
(301) 746-8668
Mailing address
305 DORN AVE, CUMBERLAND, MD 21502-3225
(240) 362-3188
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
A0000671
MD
2255A2300X
Athletic Trainer
AT001691
WV
Other
Enumeration date
07/19/2021
Last updated
05/30/2024
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