MEDICARE: KELSEY BLETSCH

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	225200000X	Physical Therapy Assistant	09955	OH

General Provider Information

NPI Number	:	1548702731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY BLETSCH

Provider Business Mailing Address
First Line	:	6075 WEXFORD PARK DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43228-9258
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6075 WEXFORD PARK DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43228-9258
Country	:	US
Telephone Number	:	440-668-5695
Fax Number	:

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

Provider Enumeration Date	:	11/06/2016
Last Update Date	:	11/06/2016

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Directions to “ KELSEY BLETSCH ” Practice Location

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