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General NPI Number Information
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NPI Number | 1205206653
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Entity Type | Individual
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Provider Name | KELSEY LYNN HIEB MS, ATC, LAT
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Gender | Female
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Dates
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Enumeration Date | 09/29/2015
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Last Update Date | 10/22/2025
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Provider Practice Location Address
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Address Line | 14121 OLD COLUMBIA PIKE
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City | BURTONSVILLE
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State | MD
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Zip | 20866-1721
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Country | US
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Telephone | 847-858-3032
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Fax | 847-858-3032
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Provider Business Mailing Address
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Address Line | 305 COWMAN CT APT 10202
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City | ODENTON
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State | MD
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Zip | 21113-3049
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Country | US
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Telephone | 847-858-3032
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Fax |
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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 | 096.003579
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | A0000760
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License Number State | MD
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