Provider Demographics
NPI:1790508927
Name:THOMPSON, KELSEY N (MA)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:N
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4786 GATEWAY DR
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-7942
Mailing Address - Country:US
Mailing Address - Phone:216-205-6011
Mailing Address - Fax:
Practice Address - Street 1:4786 GATEWAY DR
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-7942
Practice Address - Country:US
Practice Address - Phone:216-205-6011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care