Active NPI
Samantha Kelley, AT, ATC
- Athletic Trainer
- Bucyrus, OH
National Provider Identifier
1235670167
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AT004481
- Practice address
- 140 Hill St Ste B
Bucyrus, OH 44820-1566 - Phone
- (614) 940-8678
- NPI assigned
- Mar 11, 2017
- Last updated
- Mar 11, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | AT004481 | OH | Primary |
Addresses
Primary practice location
140 Hill St Ste B
Bucyrus, OH 44820-1566
Mailing address
361 Maplewood Ave
Columbus, OH 43213-1732
Phone (614) 940-8678
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AT004481 | OH | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1489190400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1489190400000",
"number": "1235670167",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "361 MAPLEWOOD AVE",
"city": "COLUMBUS",
"state": "OH",
"postal_code": "432131732",
"telephone_number": "614-940-8678"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "140 HILL ST STE B",
"city": "BUCYRUS",
"state": "OH",
"postal_code": "448201566",
"telephone_number": "614-940-8678"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLEY",
"first_name": "SAMANTHA",
"credential": "AT, ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-03-11",
"last_updated": "2017-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "OH",
"license": "AT004481",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bucyrus, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.