Healthcare Provider Details

I. General information

NPI: 1932779907
Provider Name (Legal Business Name): KELSEY HAIR OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 FESTIVAL PARK PLZ
CHESTER VA
23831-4449
US

IV. Provider business mailing address

PO BOX 412307
BOSTON MA
02241-2307
US

V. Phone/Fax

Practice location:
  • Phone: 804-930-8280
  • Fax: 804-930-8101
Mailing address:
  • Phone: 914-294-4050
  • Fax: 631-760-8306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119009091
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: