MEDICARE: KELSEY STURGEON

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	225X00000X	Occupational Therapist	268521	KY

General Provider Information

NPI Number	:	1689340044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY STURGEON

Provider Business Mailing Address
First Line	:	205 MOSS WAY
Second Line	:
City	:	GLASGOW
State	:	KY
Zip	:	42141-8227
Country	:	US
Telephone Number	:	270-590-0693
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 SKYLINE DR
Second Line	:
City	:	EDMONTON
State	:	KY
Zip	:	42129-8131
Country	:	US
Telephone Number	:	270-590-0693
Fax Number	:

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

Provider Enumeration Date	:	08/17/2021
Last Update Date	:	08/17/2021

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Directions to “ KELSEY STURGEON ” Practice Location

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