Provider Demographics
NPI:1003663519
Name:GRABER, KELSEY MARIE
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:MARIE
Last Name:GRABER
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:PO BOX 1414
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:28329-1414
Mailing Address - Country:US
Mailing Address - Phone:910-299-0700
Mailing Address - Fax:910-299-0800
Practice Address - Street 1:2135 VALLEYGATE DR STE 101
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3751
Practice Address - Country:US
Practice Address - Phone:910-299-0700
Practice Address - Fax:910-299-0800
Is Sole Proprietor?:No
Enumeration Date:2024-05-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15355225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist