Provider Demographics
NPI:1164838637
Name:GARTNER, KELSIE (MS, AT)
Entity Type:Individual
Prefix:
First Name:KELSIE
Middle Name:
Last Name:GARTNER
Suffix:
Gender:F
Credentials:MS, AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 103
Mailing Address - Street 2:
Mailing Address - City:GENESEE
Mailing Address - State:ID
Mailing Address - Zip Code:83832-0103
Mailing Address - Country:US
Mailing Address - Phone:208-310-6004
Mailing Address - Fax:
Practice Address - Street 1:640 W HAZEL ST
Practice Address - Street 2:
Practice Address - City:GENESEE
Practice Address - State:ID
Practice Address - Zip Code:83832-9547
Practice Address - Country:US
Practice Address - Phone:208-310-6004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-06
Last Update Date:2014-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer