Provider Demographics
NPI:1740645803
Name:MATHIAS, KELSEY (OTR)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:MATHIAS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1844 BEAMREACH PL
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-6725
Mailing Address - Country:US
Mailing Address - Phone:970-294-2897
Mailing Address - Fax:
Practice Address - Street 1:1844 BEAMREACH PL
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-6725
Practice Address - Country:US
Practice Address - Phone:970-294-2897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-16
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0004487225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist