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General NPI Number Information
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NPI Number | 1700651759
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Entity Type | Individual
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Provider Name | KELLI STETSON ATC
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Gender | Female
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Dates
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Enumeration Date | 11/20/2023
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Last Update Date | 11/20/2023
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Provider Practice Location Address
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Address Line | 5302 55TH STREET
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City | SAN DIEGO
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State | CA
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Zip | 92115
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Country | US
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Telephone | 619-701-0222
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Fax |
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Provider Business Mailing Address
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Address Line | 10313 SAN DIEGO MISSION RD APT 117
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City | SAN DIEGO
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State | CA
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Zip | 92108-2155
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Country | US
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Telephone | 619-701-0222
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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 |
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License Number State |
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