MEDICARE: MR. BRIAN SCOTT KELSEY C.P.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	222Z00000X	Orthotist
2	224P00000X	Prosthetist

General Provider Information

NPI Number	:	1083610604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRIAN SCOTT KELSEY C.P.O.

Provider Business Mailing Address
First Line	:	6790 WEST LAYTON AVENUE
Second Line	:
City	:	GREENFIELD
State	:	WI
Zip	:	53220-4571
Country	:	US
Telephone Number	:	414-282-3100
Fax Number	:	414-282-3101

Provider Business Practice Location Address
First Line	:	6790 WEST LAYTON AVENUE
Second Line	:
City	:	GREENFIELD
State	:	WI
Zip	:	53220-4571
Country	:	US
Telephone Number	:	414-282-3100
Fax Number	:	414-282-3101

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	02/24/2025

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