Provider Demographics
NPI:1245601822
Name:BUELOW, KELSEY (MOT)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:BUELOW
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:
Other - Last Name:STAVENAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT
Mailing Address - Street 1:40520 COUNTY HIGHWAY 34
Mailing Address - Street 2:
Mailing Address - City:OGEMA
Mailing Address - State:MN
Mailing Address - Zip Code:56569-9612
Mailing Address - Country:US
Mailing Address - Phone:218-983-6229
Mailing Address - Fax:218-983-6217
Practice Address - Street 1:40520 COUNTY HIGHWAY 34
Practice Address - Street 2:
Practice Address - City:OGEMA
Practice Address - State:MN
Practice Address - Zip Code:56569-9612
Practice Address - Country:US
Practice Address - Phone:218-983-6229
Practice Address - Fax:218-983-6217
Is Sole Proprietor?:No
Enumeration Date:2015-10-08
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist