Provider Demographics
NPI:1295006963
Name:GRIFFIN, KELLY (MS, ATC)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 500
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03216
Mailing Address - Country:US
Mailing Address - Phone:603-735-6258
Mailing Address - Fax:603-735-5999
Practice Address - Street 1:204 MAIN STREET
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:NH
Practice Address - Zip Code:03216
Practice Address - Country:US
Practice Address - Phone:603-735-6258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-26
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH04142255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer