Provider Demographics
NPI:1184290520
Name:SWAILES, KELSEY G (OTD)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:G
Last Name:SWAILES
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:G
Other - Last Name:FINN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:128 E OLIN AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-1467
Mailing Address - Country:US
Mailing Address - Phone:608-252-1320
Mailing Address - Fax:608-252-1333
Practice Address - Street 1:128 E OLIN AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-1467
Practice Address - Country:US
Practice Address - Phone:608-252-1320
Practice Address - Fax:608-252-1333
Is Sole Proprietor?:No
Enumeration Date:2021-05-27
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI225X00000X
WAOT61306577225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics