Provider Demographics
NPI:1124556212
Name:OLSEN, KELSEY NICHOLE (ATC)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:NICHOLE
Last Name:OLSEN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16456 OLD HIGHWAY 15
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-8592
Mailing Address - Country:US
Mailing Address - Phone:228-860-1040
Mailing Address - Fax:
Practice Address - Street 1:333 BEN WEINER DR
Practice Address - Street 2:SUITE #154
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118
Practice Address - Country:US
Practice Address - Phone:504-865-5511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-01
Last Update Date:2017-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer