Provider Demographics
NPI:1023785599
Name:TZOBANAKIS, KELSEY D'NAE (OTR, CHT)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:D'NAE
Last Name:TZOBANAKIS
Suffix:
Gender:F
Credentials:OTR, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10120 WESTPARK DR
Mailing Address - Street 2:
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76126-4045
Mailing Address - Country:US
Mailing Address - Phone:325-721-1931
Mailing Address - Fax:
Practice Address - Street 1:5612 EDWARDS RANCH RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-4145
Practice Address - Country:US
Practice Address - Phone:817-420-9238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114009225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist