Healthcare Provider Details

I. General information

NPI: 1407238512
Provider Name (Legal Business Name): KELSEY LARKEY ATC, LAT, CSA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2015
Last Update Date: 06/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6144 N BRANDYWINE RD
SHELBYVILLE IN
46176-9383
US

IV. Provider business mailing address

6144 N BRANDYWINE RD
SHELBYVILLE IN
46176-9383
US

V. Phone/Fax

Practice location:
  • Phone: 317-695-6549
  • Fax:
Mailing address:
  • Phone: 317-695-6549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number36002417A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: