Provider Demographics
NPI:1407206519
Name:THOMAS, KELSEY (AUD)
Entity Type:Individual
Prefix:DR
First Name:KELSEY
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 LAKE BALDWIN LN
Mailing Address - Street 2:STE. A
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32814-6684
Mailing Address - Country:US
Mailing Address - Phone:407-898-2220
Mailing Address - Fax:877-769-2047
Practice Address - Street 1:1460 LAKE BALDWIN LN
Practice Address - Street 2:STE. A
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32814-6684
Practice Address - Country:US
Practice Address - Phone:407-898-2220
Practice Address - Fax:877-769-2047
Is Sole Proprietor?:No
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY2048231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist