Provider Demographics
NPI:1104885276
Name:KIMMEL, KELLY LYNN (ATC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:LYNN
Last Name:KIMMEL
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 1:402 COLONIAL RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012-2334
Mailing Address - Country:US
Mailing Address - Phone:410-991-8234
Mailing Address - Fax:
Practice Address - Street 1:402 COLONIAL RIDGE LN
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MD
Practice Address - Zip Code:21012-2334
Practice Address - Country:US
Practice Address - Phone:410-991-8234
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer