Healthcare Provider Details

I. General information

NPI: 1407206519
Provider Name (Legal Business Name): KELSEY THOMAS AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2016
Last Update Date: 06/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 LAKE BALDWIN LN STE. A
ORLANDO FL
32814-6684
US

IV. Provider business mailing address

1460 LAKE BALDWIN LN STE. A
ORLANDO FL
32814-6684
US

V. Phone/Fax

Practice location:
  • Phone: 407-898-2220
  • Fax: 877-769-2047
Mailing address:
  • Phone: 407-898-2220
  • Fax: 877-769-2047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY2048
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: