Individual
MISS KELLI ALISA HUDSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
1635 18TH AVE, WALL TOWNSHIP, NJ 07719-3723
(732) 221-8702
Mailing address
1635 18TH AVE, WALL TOWNSHIP, NJ 07719-3723
(732) 221-8702
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
25MT00114300
NJ
390200000X
Student in an Organized Health Care Education/Training Program
25MT00114300
NJ
Other
Enumeration date
04/12/2007
Last updated
10/26/2016
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