Provider Demographics
NPI:1033575667
Name:AHLVERS, KELSEY ROCHELLE
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:ROCHELLE
Last Name:AHLVERS
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 1:528 BLACKSTONE DR
Mailing Address - Street 2:
Mailing Address - City:SPRING CREEK
Mailing Address - State:NV
Mailing Address - Zip Code:89815-5337
Mailing Address - Country:US
Mailing Address - Phone:775-385-6247
Mailing Address - Fax:
Practice Address - Street 1:528 BLACKSTONE DR
Practice Address - Street 2:
Practice Address - City:SPRING CREEK
Practice Address - State:NV
Practice Address - Zip Code:89815-5337
Practice Address - Country:US
Practice Address - Phone:775-385-6247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-12
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1780936435Medicaid