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NPI Code Detail

MEDICARE: KELSEY D LARGE L.M.T.

MEDICARE: KELSEY D LARGE L.M.T.
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
1171M00000XCase Manager/Care Coordinator
2225700000XMassage Therapist15714OH
3172V00000XCommunity Health Worker

General Provider Information

NPI Number : 1235417189
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELSEY D LARGE L.M.T.
Provider Business Mailing Address
First Line : PO BOX 132
Second Line :
City : ATHENS
State : OH
Zip : 45701-0132
Country : US
Telephone Number : 800-321-8293
Fax Number :
Provider Business Practice Location Address
First Line : 2527 W BROAD ST
Second Line :
City : COLUMBUS
State : OH
Zip : 43204-3322
Country : US
Telephone Number : 614-279-2525
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2011
Last Update Date : 08/07/2025

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