Provider Demographics
NPI:1093883837
Name:SABISTON, KELLI BREWER (MA, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:BREWER
Last Name:SABISTON
Suffix:
Gender:F
Credentials:MA, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:SHALLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28470-4422
Mailing Address - Country:US
Mailing Address - Phone:910-755-3334
Mailing Address - Fax:
Practice Address - Street 1:19 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:SHALLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28470-4422
Practice Address - Country:US
Practice Address - Phone:910-755-3334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer