Provider Demographics
NPI:1477316990
Name:KETELSEN, GINA FALEEN
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:FALEEN
Last Name:KETELSEN
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 1:14028 208TH PL
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:SD
Mailing Address - Zip Code:57785-6643
Mailing Address - Country:US
Mailing Address - Phone:605-490-9904
Mailing Address - Fax:
Practice Address - Street 1:14028 208TH PL
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:SD
Practice Address - Zip Code:57785-6643
Practice Address - Country:US
Practice Address - Phone:605-490-9904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes226000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreational Therapist Assistant