Provider Demographics
NPI:1417282070
Name:NELSON, KELSEY MICHELLE (MOTR/L)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:MICHELLE
Last Name:NELSON
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:MICHELLE
Other - Last Name:HEWITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOTR/L
Mailing Address - Street 1:PO BOX 1790
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:WY
Mailing Address - Zip Code:82633-1790
Mailing Address - Country:US
Mailing Address - Phone:307-358-9464
Mailing Address - Fax:307-358-9330
Practice Address - Street 1:111 S 5TH ST
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:WY
Practice Address - Zip Code:82633-2434
Practice Address - Country:US
Practice Address - Phone:307-358-9464
Practice Address - Fax:307-358-9330
Is Sole Proprietor?:No
Enumeration Date:2009-10-14
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYOTR-816225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist