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General NPI Number Information
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NPI Number | 1497736953
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Entity Type | Individual
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Provider Name | KELLI MICHELLE HOWARD ATC/L
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Gender | Female
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Dates
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Enumeration Date | 11/10/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1235 E CHEROKEE ST
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City | SPRINGFIELD
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State | MO
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Zip | 65804-2203
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Country | US
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Telephone | 417-820-7990
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Fax |
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Provider Business Mailing Address
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Address Line | 710 E CURRENT DR
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City | OZARK
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State | MO
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Zip | 65721-4241
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Country | US
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Telephone | 417-582-1638
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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 | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number | 2004018744
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License Number State | MO
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