Provider Demographics
NPI:1114527090
Name:POMARE DESCHENE, KELSEY (BA)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:POMARE DESCHENE
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:
Other - Last Name:POMARE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22 CURRIER AVE
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-6441
Mailing Address - Country:US
Mailing Address - Phone:617-596-4123
Mailing Address - Fax:
Practice Address - Street 1:22 CURRIER AVE
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-6441
Practice Address - Country:US
Practice Address - Phone:617-596-4123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist