Provider Demographics
NPI:1326401407
Name:QUINNELL, KELSEY (ATC)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:QUINNELL
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:
Other - Last Name:CLAUSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:101 S GROVE ST
Mailing Address - Street 2:
Mailing Address - City:BARNEVELD
Mailing Address - State:WI
Mailing Address - Zip Code:53507-9589
Mailing Address - Country:US
Mailing Address - Phone:608-279-0194
Mailing Address - Fax:
Practice Address - Street 1:4100 STATE HIGHWAY 66
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54482-8410
Practice Address - Country:US
Practice Address - Phone:715-343-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-05
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAT-2668174400000X
WI1686-392081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
No174400000XOther Service ProvidersSpecialist