Provider Demographics
NPI:1205206653
Name:HIEB, KELSEY LYNN (MS, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:LYNN
Last Name:HIEB
Suffix:
Gender:F
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8222 BRUSHYRIDGE RD
Mailing Address - Street 2:APT 2E
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20724-6033
Mailing Address - Country:US
Mailing Address - Phone:847-858-3032
Mailing Address - Fax:
Practice Address - Street 1:6808 HARROWDALE RD
Practice Address - Street 2:APT #101
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-1831
Practice Address - Country:US
Practice Address - Phone:847-858-3032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-29
Last Update Date:2017-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00007602255A2300X
IL096.0035792255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer