Provider Demographics
NPI:1558637868
Name:ENFIELD, KELLY L (ATC/L)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:L
Last Name:ENFIELD
Suffix:
Gender:F
Credentials:ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17026 426TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:WA
Mailing Address - Zip Code:98045-9345
Mailing Address - Country:US
Mailing Address - Phone:425-736-1475
Mailing Address - Fax:
Practice Address - Street 1:17050 431ST AVE SE
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:WA
Practice Address - Zip Code:98045-9650
Practice Address - Country:US
Practice Address - Phone:425-736-1475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-30
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer