Provider Demographics
NPI:1902418106
Name:ADAMS, KELLI BRIANNA (ATC, LAT)
Entity Type:Individual
Prefix:MS
First Name:KELLI
Middle Name:BRIANNA
Last Name:ADAMS
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 INSPIRATION AVE APT 5306
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-6347
Mailing Address - Country:US
Mailing Address - Phone:864-237-0608
Mailing Address - Fax:
Practice Address - Street 1:12 HE MCCRACKEN CIR
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-5866
Practice Address - Country:US
Practice Address - Phone:864-237-0608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
SC2255A2300X
SCSC5313092255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer