Provider Demographics
NPI:1215959895
Name:SCHELLHASE, KRISTEN COUPER (MED, ATC, LAT, CSCS)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:COUPER
Last Name:SCHELLHASE
Suffix:
Gender:F
Credentials:MED, ATC, LAT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 S BINION RD
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-1604
Mailing Address - Country:US
Mailing Address - Phone:407-823-3463
Mailing Address - Fax:407-823-6138
Practice Address - Street 1:4000 CENTRAL FLORIDA BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32816-2205
Practice Address - Country:US
Practice Address - Phone:407-823-3463
Practice Address - Fax:407-823-6138
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 10472255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer