Provider Demographics
NPI:1699275859
Name:KELLOGG, JAMES WESTON (ATC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:WESTON
Last Name:KELLOGG
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 ROUTE 22
Mailing Address - Street 2:
Mailing Address - City:PAWLING
Mailing Address - State:NY
Mailing Address - Zip Code:12564-1254
Mailing Address - Country:US
Mailing Address - Phone:845-797-9815
Mailing Address - Fax:
Practice Address - Street 1:TRINITY-PAWLING SCHOOL
Practice Address - Street 2:700 ROUTE 22
Practice Address - City:PAWLING
Practice Address - State:NY
Practice Address - Zip Code:12564
Practice Address - Country:US
Practice Address - Phone:845-797-9815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-14
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0001082255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer