Provider Demographics
NPI:1275029654
Name:WHITTIER, KELSEY JEANETTE
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:JEANETTE
Last Name:WHITTIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-1537
Mailing Address - Country:US
Mailing Address - Phone:617-469-3080
Mailing Address - Fax:617-469-3085
Practice Address - Street 1:25 WILLOW ST
Practice Address - Street 2:
Practice Address - City:WEST ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132-1537
Practice Address - Country:US
Practice Address - Phone:617-469-3080
Practice Address - Fax:617-469-3085
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist