Provider Demographics
NPI:1942876347
Name:ALDWORTH, KELSEY WIN
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:WIN
Last Name:ALDWORTH
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 1:6206 SHAWNEE CIR
Mailing Address - Street 2:
Mailing Address - City:SCOTTS
Mailing Address - State:MI
Mailing Address - Zip Code:49088-9766
Mailing Address - Country:US
Mailing Address - Phone:269-254-3622
Mailing Address - Fax:
Practice Address - Street 1:6206 SHAWNEE CIR
Practice Address - Street 2:
Practice Address - City:SCOTTS
Practice Address - State:MI
Practice Address - Zip Code:49088-9766
Practice Address - Country:US
Practice Address - Phone:269-254-3622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer