Provider Demographics
NPI:1114065422
Name:CHANSKY, KELLY ANN (OTR)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:ANN
Last Name:CHANSKY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4103 60TH ST
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53144-2509
Mailing Address - Country:US
Mailing Address - Phone:262-652-1111
Mailing Address - Fax:262-652-1124
Practice Address - Street 1:4103 60TH ST
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144-2509
Practice Address - Country:US
Practice Address - Phone:262-652-1111
Practice Address - Fax:262-652-1124
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3534-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41040200Medicaid
WI41040200Medicaid