Provider Demographics
NPI:1306408166
Name:RIZZO, KELSEY DANTE (COTA/L)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:DANTE
Last Name:RIZZO
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 VICE ST
Mailing Address - Street 2:
Mailing Address - City:VANCEBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41179-7837
Mailing Address - Country:US
Mailing Address - Phone:606-202-1237
Mailing Address - Fax:
Practice Address - Street 1:58 EASTHAM ST
Practice Address - Street 2:
Practice Address - City:VANCEBURG
Practice Address - State:KY
Practice Address - Zip Code:41179-5462
Practice Address - Country:US
Practice Address - Phone:606-796-3046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-02
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY243483224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant