Provider Demographics
NPI:1033652599
Name:BRANDES, KELSIE
Entity Type:Individual
Prefix:
First Name:KELSIE
Middle Name:
Last Name:BRANDES
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 1:10389 HIGHWAY A
Mailing Address - Street 2:
Mailing Address - City:MORA
Mailing Address - State:MO
Mailing Address - Zip Code:65345-2116
Mailing Address - Country:US
Mailing Address - Phone:660-287-0524
Mailing Address - Fax:
Practice Address - Street 1:3333 W 10TH ST
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-2113
Practice Address - Country:US
Practice Address - Phone:660-826-2118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015036820225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant