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General NPI Number Information
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NPI Number | 1457150989
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Entity Type | Individual
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Provider Name | KELSEY LYNN COLVIN OTR/L
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Gender | Female
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Dates
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Enumeration Date | 03/08/2025
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Last Update Date | 03/08/2025
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Provider Practice Location Address
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Address Line | 621 S 4TH ST
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City | LE SUEUR
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State | MN
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Zip | 56058-2203
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Country | US
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Telephone | 507-665-8689
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Fax |
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Provider Business Mailing Address
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Address Line | 730 DAKOTA PT
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City | JORDAN
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State | MN
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Zip | 55352-1440
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Country | US
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Telephone | 612-990-4367
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 107100
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License Number State | MN
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