MEDICARE: NOAH KELLS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	AT00609	OH

General Provider Information

NPI Number	:	1538896329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOAH KELLS

Provider Business Mailing Address
First Line	:	1956 MERGANSER RUN DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43215-7019
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3638 EDWARDS RD APT 3
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45208-1333
Country	:	US
Telephone Number	:	206-963-3396
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2022
Last Update Date	:	08/02/2022

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Directions to “ NOAH KELLS ” Practice Location

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