Provider Demographics
NPI:1104366517
Name:KITTLER, KELSEY ANN (OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:KELSEY
Middle Name:ANN
Last Name:KITTLER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 S JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:NEW ULM
Mailing Address - State:MN
Mailing Address - Zip Code:56073-3241
Mailing Address - Country:US
Mailing Address - Phone:507-217-1184
Mailing Address - Fax:
Practice Address - Street 1:1107 HART BLVD STE 10
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:MN
Practice Address - Zip Code:55362-8539
Practice Address - Country:US
Practice Address - Phone:763-295-6878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-03
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN105354225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist