MEDICARE: MISS KELLY LYNN HENSCHEL ATC

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	225700000X	Massage Therapist	15481	TN
2	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1114386836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS KELLY LYNN HENSCHEL ATC

Provider Business Mailing Address
First Line	:	1313 CLEARBROOK CT
Second Line	:
City	:	FORT OGLETHORPE
State	:	GA
Zip	:	30742-3247
Country	:	US
Telephone Number	:	954-830-8346
Fax Number	:

Provider Business Practice Location Address
First Line	:	1313 CLEARBROOK CT
Second Line	:
City	:	FORT OGLETHORPE
State	:	GA
Zip	:	30742-3247
Country	:	US
Telephone Number	:	954-830-8346
Fax Number	:

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

Provider Enumeration Date	:	02/23/2016
Last Update Date	:	11/19/2025

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