Provider Demographics
NPI:1003052564
Name:HALL, KELSEY JAMES
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:JAMES
Last Name:HALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 SHARON MOSS RD
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39443-0959
Mailing Address - Country:US
Mailing Address - Phone:601-498-5578
Mailing Address - Fax:
Practice Address - Street 1:2118 SANDY LN
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39443-9087
Practice Address - Country:US
Practice Address - Phone:601-342-2923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-05
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112078225X00000X
MS3183225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist