Provider Demographics
NPI:1205303377
Name:EISENHAUER, KELSEY LEE (MT-BC)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:LEE
Last Name:EISENHAUER
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 UMBERTO AVE
Mailing Address - Street 2:
Mailing Address - City:NEW CUMBERLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17070-2628
Mailing Address - Country:US
Mailing Address - Phone:720-480-4501
Mailing Address - Fax:
Practice Address - Street 1:59 AVENUE D
Practice Address - Street 2:PERRY POINT
Practice Address - City:PERRYVILLE
Practice Address - State:MD
Practice Address - Zip Code:21078
Practice Address - Country:US
Practice Address - Phone:410-642-2411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-26
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic TherapistGroup - Single Specialty