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NPI Code Detail

MEDICARE: KELSEY ELIZABETH HERMAN

MEDICARE: KELSEY ELIZABETH HERMAN
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
1225X00000XOccupational TherapistOT60999392WA

General Provider Information

NPI Number : 1730719931
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELSEY ELIZABETH HERMAN
Provider Business Mailing Address
First Line : 2965 E TARPON DR STE 150
Second Line :
City : MERIDIAN
State : ID
Zip : 83642-9007
Country : US
Telephone Number : 208-287-9420
Fax Number :
Provider Business Practice Location Address
First Line : 7409 NE HAZEL DELL AVE STE 112
Second Line :
City : VANCOUVER
State : WA
Zip : 98665-8337
Country : US
Telephone Number : 360-597-4048
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/16/2020
Last Update Date : 01/16/2020

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Directions to “ KELSEY ELIZABETH HERMAN ” Practice Location

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