Provider Demographics
NPI:1578172110
Name:GREGERSON, KELSEY ROSE (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:ROSE
Last Name:GREGERSON
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 S 186TH PLZ APT 104
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:NE
Mailing Address - Zip Code:68022-5402
Mailing Address - Country:US
Mailing Address - Phone:402-536-0484
Mailing Address - Fax:
Practice Address - Street 1:20650 GLENN ST
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-2324
Practice Address - Country:US
Practice Address - Phone:402-289-2579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-29
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2382225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist