Healthcare Provider Details

I. General information

NPI: 1942852405
Provider Name (Legal Business Name): KELSEY MARIE DELKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2019
Last Update Date: 11/15/2021
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 S HIGHWAY 27
CLERMONT FL
34711-6816
US

IV. Provider business mailing address

629 JAMESTOWN BLVD APT 2224
ALTAMONTE SPRINGS FL
32714-4635
US

V. Phone/Fax

Practice location:
  • Phone: 352-394-0212
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number17085
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: