Healthcare Provider Details

I. General information

NPI: 1245158682
Provider Name (Legal Business Name): KELSEY MORAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 AZALEA TER
FORT THOMAS KY
41075-1405
US

IV. Provider business mailing address

54 AZALEA TER
FORT THOMAS KY
41075-1405
US

V. Phone/Fax

Practice location:
  • Phone: 419-889-5196
  • Fax:
Mailing address:
  • Phone: 419-889-5196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT.0009393
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: