MEDICARE: KELLY LEE OZELSKI LMFT

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	106H00000X	Marriage & Family Therapist	MF000948	PA

General Provider Information

NPI Number	:	1376051771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY LEE OZELSKI LMFT

Provider Business Mailing Address
First Line	:	160 S 22ND ST
Second Line	:
City	:	LEBANON
State	:	PA
Zip	:	17042-2559
Country	:	US
Telephone Number	:	717-926-6760
Fax Number	:

Provider Business Practice Location Address
First Line	:	752 WILLOW ST
Second Line	:
City	:	LEBANON
State	:	PA
Zip	:	17046-5066
Country	:	US
Telephone Number	:	717-926-6760
Fax Number	:	877-250-4210

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

Provider Enumeration Date	:	01/19/2018
Last Update Date	:	06/16/2018

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