Provider Demographics
NPI:1417413428
Name:KELL, KRISTEN J (BSK, ATS)
Entity Type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:J
Last Name:KELL
Suffix:
Gender:F
Credentials:BSK, ATS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3532 NW 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-1508
Mailing Address - Country:US
Mailing Address - Phone:360-751-3110
Mailing Address - Fax:
Practice Address - Street 1:3532 NW 3RD AVE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-1508
Practice Address - Country:US
Practice Address - Phone:360-751-3110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-14
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer