Provider Demographics
NPI:1225716285
Name:MOOSMANN, KELSIE JANE (OTR/L)
Entity Type:Individual
Prefix:
First Name:KELSIE
Middle Name:JANE
Last Name:MOOSMANN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8117 MIDDLEBURY AVE
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-7722
Mailing Address - Country:US
Mailing Address - Phone:630-559-5708
Mailing Address - Fax:
Practice Address - Street 1:95 CARLETON AVE
Practice Address - Street 2:
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-5500
Practice Address - Country:US
Practice Address - Phone:630-469-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.015521225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist