MEDICARE: KELDA ELIZABETH NELSON LCAT, ATR.BC

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	221700000X	Art Therapist	001418	NY

General Provider Information

NPI Number	:	1316502818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELDA ELIZABETH NELSON LCAT, ATR.BC

Provider Business Mailing Address
First Line	:	259 W 121ST ST APT 1A
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10027-6286
Country	:	US
Telephone Number	:	646-403-0597
Fax Number	:

Provider Business Practice Location Address
First Line	:	116 W 23RD ST FL 5
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10011-2599
Country	:	US
Telephone Number	:	917-780-2171
Fax Number	:

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

Provider Enumeration Date	:	05/09/2019
Last Update Date	:	05/09/2019

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