Provider Demographics
NPI:1457900961
Name:AULT, KELSEY (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:AULT
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 OAKHURST DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25314-2049
Mailing Address - Country:US
Mailing Address - Phone:304-345-8101
Mailing Address - Fax:
Practice Address - Street 1:1015 OAKHURST DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25314-2049
Practice Address - Country:US
Practice Address - Phone:304-345-8101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-06
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2062225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist