Provider Demographics
NPI:1659822450
Name:CLEAVER, KELLY C (ATC)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:C
Last Name:CLEAVER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 N MCAULIFF ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93292-9310
Mailing Address - Country:US
Mailing Address - Phone:559-802-6436
Mailing Address - Fax:559-622-3314
Practice Address - Street 1:1717 N MCAULIFF ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93292-9310
Practice Address - Country:US
Practice Address - Phone:559-802-6436
Practice Address - Fax:559-622-3314
Is Sole Proprietor?:No
Enumeration Date:2016-10-18
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20000255652255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer