Individual provider · NPI-1

Donovan Kelly, LAT, ATC

Specialist/Technologist, Athletic Trainer · Brockton, MA

NPI number1427611722
StatusActive
Last updated in NPPESApr 22, 2019

Details

NPI
1427611722
Entity type
Individual (NPI-1)
Name
Donovan Kelly
Credential
LAT, ATC
Sex
Male
Sole proprietor
No
Enumeration date
Apr 22, 2019
Last updated
Apr 22, 2019

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
2255A2300X Specialist/Technologist, Athletic Trainer3125MAYes

Practice location

110 Liberty St
Brockton, MA 02301-5674

Phone 508-565-3055

Mailing address

1010 Middle St Apt 6
Weymouth, MA 02188-3958

Phone 802-299-8250

Other practice locations

245 S Franklin St
Holbrook, MA 02343-1494

Phone 802-299-8250

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