Provider Demographics
NPI:1972089605
Name:NANSEL, KATHLEEN (BA, CFSP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:NANSEL
Suffix:
Gender:F
Credentials:BA, CFSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 MCKINLEY AVE
Mailing Address - Street 2:
Mailing Address - City:KELLOGG
Mailing Address - State:ID
Mailing Address - Zip Code:83837-2693
Mailing Address - Country:US
Mailing Address - Phone:208-783-1454
Mailing Address - Fax:
Practice Address - Street 1:740 MCKINLEY AVE
Practice Address - Street 2:
Practice Address - City:KELLOGG
Practice Address - State:ID
Practice Address - Zip Code:83837
Practice Address - Country:US
Practice Address - Phone:208-783-1454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-16
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No175T00000XOther Service ProvidersPeer Specialist