Provider Demographics
NPI:1740993336
Name:BAIR, KELSEY M (MAT, LAT, ATC, CEAS)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:M
Last Name:BAIR
Suffix:
Gender:F
Credentials:MAT, LAT, ATC, CEAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5109 FOX MILL RUN
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46835-9352
Mailing Address - Country:US
Mailing Address - Phone:260-385-3418
Mailing Address - Fax:
Practice Address - Street 1:4251 LAHMEYER RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815-5676
Practice Address - Country:US
Practice Address - Phone:260-385-3418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-29
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36003707A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer