Basic Information
| Provider Information | |||||||||
| NPI: | 1083965636 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KELSOE | ||||||||
| FirstName: | ELIZABETH | ||||||||
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| Credential: | C.O.T.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3310 W MICHIGAN ST | ||||||||
| Address2: | |||||||||
| City: | EVANSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 477127814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8126047545 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3801 OLD BRUCEVILLE RD | ||||||||
| Address2: | |||||||||
| City: | VINCENNES | ||||||||
| State: | IN | ||||||||
| PostalCode: | 475913889 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8128821783 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2012 | ||||||||
| LastUpdateDate: | 09/23/2012 | ||||||||
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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 | 224Z00000X | 32001556A | IN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.