Provider Demographics
NPI:1083610604
Name:KELSEY, BRIAN SCOTT (CPO)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:SCOTT
Last Name:KELSEY
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6790 WEST LAYTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53220-4571
Mailing Address - Country:US
Mailing Address - Phone:414-282-3100
Mailing Address - Fax:414-282-3101
Practice Address - Street 1:6790 WEST LAYTON AVENUE
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-4571
Practice Address - Country:US
Practice Address - Phone:414-282-3100
Practice Address - Fax:414-282-3101
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy Fitter
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist