Provider Demographics
NPI:1225556004
Name:KESSLER, ALYCE TAYLOR (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:ALYCE
Middle Name:TAYLOR
Last Name:KESSLER
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5123 S 500 W
Mailing Address - Street 2:
Mailing Address - City:MOROCCO
Mailing Address - State:IN
Mailing Address - Zip Code:47963-8066
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5123 S 500 W
Practice Address - Street 2:
Practice Address - City:MOROCCO
Practice Address - State:IN
Practice Address - Zip Code:47963-8066
Practice Address - Country:US
Practice Address - Phone:219-869-4825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-31
Last Update Date:2019-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT79082255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer