Provider Demographics
NPI:1164796496
Name:KELSEY PROSTHETICS ORTHOTICS LLC
Entity Type:Organization
Organization Name:KELSEY PROSTHETICS ORTHOTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KELSEY
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:414-282-3100
Mailing Address - Street 1:6790 W LAYTON AVE
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53220-4571
Mailing Address - Country:US
Mailing Address - Phone:414-282-3100
Mailing Address - Fax:414-282-3101
Practice Address - Street 1:6790 W LAYTON AVE
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-4571
Practice Address - Country:US
Practice Address - Phone:414-282-3100
Practice Address - Fax:414-282-3101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-05
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier