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NPI Code Detail

MEDICARE: KELSEY FREEZE

MEDICARE: KELSEY FREEZE
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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1972124410
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELSEY FREEZE
Provider Business Mailing Address
First Line : 3121 N OAK STREET EXT
Second Line :
City : VALDOSTA
State : GA
Zip : 31602-1099
Country : US
Telephone Number : 800-832-9419
Fax Number :
Provider Business Practice Location Address
First Line : 3121 N OAK STREET EXT
Second Line :
City : VALDOSTA
State : GA
Zip : 31602-1099
Country : US
Telephone Number : 800-832-9419
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/06/2020
Last Update Date : 05/06/2020

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Directions to “ KELSEY FREEZE ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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