Healthcare Provider Details

I. General information

NPI: 1831898139
Provider Name (Legal Business Name): KEELY BENNICI ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 07/18/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MARIGOLD LN
GREENWOOD DE
19950-2515
US

IV. Provider business mailing address

10 MARIGOLD LN
GREENWOOD DE
19950-2515
US

V. Phone/Fax

Practice location:
  • Phone: 302-242-5773
  • Fax:
Mailing address:
  • Phone: 302-242-5773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: