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General NPI Number Information
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NPI Number | 1245582493
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Entity Type | Individual
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Provider Name | KELLEY ELIZABETH HARRISON M.HRD, ATC/LAT
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Gender | Female
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Dates
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Enumeration Date | 10/12/2012
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Last Update Date | 10/12/2012
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Provider Practice Location Address
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Address Line | 600 S CLYDE MORRIS BLVD
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-3966
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Country | US
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Telephone | 386-226-7785
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Fax | 386-323-5017
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Provider Business Mailing Address
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Address Line | 173 INTEGRA BREEZE LN UNIT 104
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-5589
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Country | US
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Telephone | 850-559-1419
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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 | AL3146
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License Number State | FL
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