Provider Demographics
NPI:1336549047
Name:PAULS, KELLY
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:PAULS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6117 VEVEY LN
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29707-8632
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1793 E WATERFORD CT
Practice Address - Street 2:APARTMENT 224
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-8367
Practice Address - Country:US
Practice Address - Phone:732-379-1680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-29
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC39OtherATHLETIC TRAINING