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NPI Code Detail

MEDICARE: KELSEY BRADSHAW BCBA

MEDICARE: KELSEY BRADSHAW BCBA
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
1106S00000XBehavior TechnicianNC
2103K00000XBehavior Analyst

General Provider Information

NPI Number : 1639702517
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELSEY BRADSHAW BCBA
Provider Business Mailing Address
First Line : 2505 COUNTRY CLUB RD
Second Line :
City : WINSTON SALEM
State : NC
Zip : 27104-4105
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 770 PARK CENTRE DR
Second Line :
City : KERNERSVILLE
State : NC
Zip : 27284-3598
Country : US
Telephone Number : 704-780-4271
Fax Number : 888-261-6694
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/19/2020
Last Update Date : 02/28/2024

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Directions to “ KELSEY BRADSHAW BCBA” Practice Location

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