Provider Demographics
NPI:1629430541
Name:HUBER, KELSEY (BOCO, BOCPD, CFO)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:HUBER
Suffix:
Gender:F
Credentials:BOCO, BOCPD, CFO
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:
Other - Last Name:WAGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:708 S ROOSEVELT ST STE 2
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-0300
Mailing Address - Country:US
Mailing Address - Phone:605-359-6461
Mailing Address - Fax:
Practice Address - Street 1:708 S ROOSEVELT ST STE 2
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-0300
Practice Address - Country:US
Practice Address - Phone:605-359-6461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter