Provider Demographics
NPI:1659873370
Name:HENRY, KELSEY VIOLET (MS, ATC, LAT, CES)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:VIOLET
Last Name:HENRY
Suffix:
Gender:F
Credentials:MS, ATC, LAT, CES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2931 PANTHERSVILLE RD APT D115
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-3025
Mailing Address - Country:US
Mailing Address - Phone:417-342-0074
Mailing Address - Fax:
Practice Address - Street 1:6000 N TERMINAL PKWY
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30320-7400
Practice Address - Country:US
Practice Address - Phone:404-773-7480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-08
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0032652255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer