MEDICARE: KELSEY DESROCHES

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1235823840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY DESROCHES

Provider Business Mailing Address
First Line	:	103 PROVIDENCE HWY
Second Line	:
City	:	EAST WALPOLE
State	:	MA
Zip	:	02032-1512
Country	:	US
Telephone Number	:	781-255-0500
Fax Number	:

Provider Business Practice Location Address
First Line	:	103 PROVIDENCE HWY
Second Line	:
City	:	EAST WALPOLE
State	:	MA
Zip	:	02032-1512
Country	:	US
Telephone Number	:	781-255-0500
Fax Number	:

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

Provider Enumeration Date	:	06/06/2023
Last Update Date	:	09/17/2024

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Directions to “ KELSEY DESROCHES ” Practice Location

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