Provider Demographics
NPI:1801587910
Name:BOUSQUET, KELSEY LYNN (OTR)
Entity type:Individual
Prefix:MS
First Name:KELSEY
Middle Name:LYNN
Last Name:BOUSQUET
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 1:125 TARA LN
Mailing Address - Street 2:
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-3950
Mailing Address - Country:US
Mailing Address - Phone:401-477-4043
Mailing Address - Fax:
Practice Address - Street 1:1 RANDALL SQ STE 301
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-2773
Practice Address - Country:US
Practice Address - Phone:401-443-5252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIOT02187225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist