Provider Demographics
NPI:1265923643
Name:BRANNOCK, KELSEY (MPS, ATR-P)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:BRANNOCK
Suffix:
Gender:F
Credentials:MPS, ATR-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6863 LAKESIDE RD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-2621
Mailing Address - Country:US
Mailing Address - Phone:561-602-1495
Mailing Address - Fax:
Practice Address - Street 1:7700 NW 48TH AVE
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-3508
Practice Address - Country:US
Practice Address - Phone:954-698-9222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist