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General NPI Number Information
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NPI Number | 1760558209
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Entity Type | Individual
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Provider Name | KELLY J TOURVILLE MED, ATC
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Gender | Female
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Dates
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Enumeration Date | 11/27/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | UNIVERSITY OF VERMONT 213 B PATRICK GYMNASIUM
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City | BURLINGTON
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State | VT
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Zip | 05405-0001
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Country | US
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Telephone | 802-656-7741
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Fax |
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Provider Business Mailing Address
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Address Line | 219 JUNIPER DR
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City | SOUTH BURLINGTON
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State | VT
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Zip | 05403-5793
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Country | US
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Telephone |
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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 | 104-0000013
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License Number State | VT
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