Provider Demographics
NPI:1093353443
Name:RASKY, KELSEY (AT, ATC)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:RASKY
Suffix:
Gender:F
Credentials:AT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 KINGS WAY
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-1188
Mailing Address - Country:US
Mailing Address - Phone:313-282-5222
Mailing Address - Fax:
Practice Address - Street 1:501 KINGS WAY
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-1188
Practice Address - Country:US
Practice Address - Phone:313-282-5222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer