Basic Information
| Provider Information | |||||||||
| NPI: | 1063971547 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ORSAK | ||||||||
| FirstName: | KELSEY | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | OTR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9330 BROADWAY ST STE 312 | ||||||||
| Address2: | |||||||||
| City: | PEARLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775847895 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8328566241 | ||||||||
| FaxNumber: | 7133839795 | ||||||||
| Practice Location | |||||||||
| Address1: | 9330 BROADWAY ST STE 312 | ||||||||
| Address2: | |||||||||
| City: | PEARLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775847895 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8328566241 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2019 | ||||||||
| LastUpdateDate: | 03/14/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 119782 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.