Provider Demographics
NPI:1427193952
Name:TOBIN, KELLI ANN (ATHLETIC TRAINER)
Entity Type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:ANN
Last Name:TOBIN
Suffix:
Gender:F
Credentials:ATHLETIC TRAINER
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:ANN
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATHLETIC TRAINER
Mailing Address - Street 1:509 FOREST HILLS PARKWAY
Mailing Address - Street 2:
Mailing Address - City:BAYVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08721
Mailing Address - Country:US
Mailing Address - Phone:732-269-1100
Mailing Address - Fax:732-269-1790
Practice Address - Street 1:509 FOREST HILLS PARKWAY
Practice Address - Street 2:
Practice Address - City:BAYVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08721
Practice Address - Country:US
Practice Address - Phone:732-269-1100
Practice Address - Fax:732-269-1790
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2008-10-02
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2008-10-02
Provider Licenses
StateLicense IDTaxonomies
NJ25MT001189002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer