Healthcare Provider Details

I. General information

NPI: 1457900961
Provider Name (Legal Business Name): KELSEY AULT OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2019
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7850 DEER CREEK DR
SACRAMENTO CA
95823-4440
US

IV. Provider business mailing address

2765 12TH ST
SACRAMENTO CA
95818-2941
US

V. Phone/Fax

Practice location:
  • Phone: 916-424-9201
  • Fax:
Mailing address:
  • Phone: 330-766-5969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number23230
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: