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General NPI Number Information
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NPI Number | 1194156471
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Entity Type | Individual
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Provider Name | KALEB FARLEY
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Gender | Male
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Dates
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Enumeration Date | 12/11/2013
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Last Update Date | 12/11/2013
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Provider Practice Location Address
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Address Line | 5714 BEVERLY DR
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City | INDIAN TRAIL
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State | NC
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Zip | 28079-8539
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Country | US
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Telephone | 704-249-0104
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Fax | 980-343-1475
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Provider Business Mailing Address
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Address Line | 5714 BEVERLY DR
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City | INDIAN TRAIL
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State | NC
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Zip | 28079-8539
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Country | US
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Telephone | 704-249-0104
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Fax | 980-343-1475
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2226
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License Number State | NC
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