Provider Demographics
NPI:1124565817
Name:KELSEY, TREVOR LEITH
Entity Type:Individual
Prefix:
First Name:TREVOR
Middle Name:LEITH
Last Name:KELSEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 ABARE AVE
Mailing Address - Street 2:
Mailing Address - City:ESSEX JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05452-2901
Mailing Address - Country:US
Mailing Address - Phone:802-825-5826
Mailing Address - Fax:
Practice Address - Street 1:7 ABARE AVE
Practice Address - Street 2:
Practice Address - City:ESSEX JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05452-2901
Practice Address - Country:US
Practice Address - Phone:802-825-5826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-19
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program