Provider Demographics
NPI:1689111965
Name:RIEFENHAUSER, KELSEY LYNN (ATC)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:LYNN
Last Name:RIEFENHAUSER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 CROFT CT
Mailing Address - Street 2:
Mailing Address - City:HAINESPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:08036-3604
Mailing Address - Country:US
Mailing Address - Phone:609-560-7284
Mailing Address - Fax:
Practice Address - Street 1:3100 MCCORMICK
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67213
Practice Address - Country:US
Practice Address - Phone:609-560-7284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS24-01053246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other