MEDICARE: KERRI REDDEN

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	25MT00183300	NJ

General Provider Information

NPI Number	:	1588059372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KERRI REDDEN

Provider Business Mailing Address
First Line	:	98 LIBERTY PL
Second Line	:
City	:	HAZLET TOWNSHIP
State	:	NJ
Zip	:	07734-3160
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	98 LIBERTY PL
Second Line	:
City	:	HAZLET TOWNSHIP
State	:	NJ
Zip	:	07734-3160
Country	:	US
Telephone Number	:	619-201-6880
Fax Number	:

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

Provider Enumeration Date	:	03/30/2015
Last Update Date	:	03/30/2015

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Directions to “ KERRI REDDEN ” Practice Location

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