Provider Demographics
NPI:1578104709
Name:ELROD, KELSEY BROOKE
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:BROOKE
Last Name:ELROD
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 1:77 COUNTY ROAD 131
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-9227
Mailing Address - Country:US
Mailing Address - Phone:870-243-7683
Mailing Address - Fax:
Practice Address - Street 1:906 E MATTHEWS AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-3050
Practice Address - Country:US
Practice Address - Phone:870-919-0274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-29
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist