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KELLY DETWILER ATC,CSCS
>> Specialist >> Other Service ProvidersRegistrant NPI Number: 1437203577
Individual Registrant: KELLY DETWILER ATC,CSCS
Gender: F
Sole Proprietor
Gender: F
Sole Proprietor
Location and contact information for practice:
40 BULLS BRIDGE RD SOUTH KENT, CT 06785-1118 US
Tel: 860-927-3539 Fax: --
Tel: 860-927-3539 Fax: --
Contact information for business:
4 PASTURE WAY NEW MILFORD, CT 06776-5632 US
Tel: -- Fax: --
Tel: -- Fax: --
Registration Information:
NPI: 1437203577
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 174400000X | Other Service Providers Specialist | CT |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
