Healthcare Provider Details

I. General information

NPI: 1285570887
Provider Name (Legal Business Name): KELSEY TOTTEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 TYLER ST STE 215
HOLLYWOOD FL
33020-4578
US

IV. Provider business mailing address

15340 NW 65TH AVENUE RD
REDDICK FL
32686-3134
US

V. Phone/Fax

Practice location:
  • Phone: 786-288-3101
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: