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SAMANTHA KELLEY
Athletic Trainer >> Specialist/Technologist >> Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersRegistrant NPI Number: 1134787740
Individual Registrant: SAMANTHA KELLEY
Gender: F
Sole Proprietor
Gender: F
Sole Proprietor
Location and contact information for practice:
100 N D ST WASHTUCNA, WA 99371-9524 US
Tel: 360-367-0033 Fax: --
Tel: 360-367-0033 Fax: --
Contact information for business:
100 N D ST WASHTUCNA, WA 99371-9524 US
Tel: -- Fax: --
Tel: -- Fax: --
Registration Information:
NPI: 1134787740
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| N | 2255A2300X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers Specialist/Technologist Athletic Trainer | ||
| Y | 390200000X | Student Organized Health Care Education/Training Program |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
