Provider Demographics
NPI:1912482894
Name:RUDD, KELSEY (MOT R/L)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:RUDD
Suffix:
Gender:F
Credentials:MOT R/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2959 SHARPSBURG MCCULLUM RD STE C
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-2297
Mailing Address - Country:US
Mailing Address - Phone:770-683-0250
Mailing Address - Fax:770-683-4250
Practice Address - Street 1:2959 SHARPSBURG MCCULLUM RD STE C
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-2297
Practice Address - Country:US
Practice Address - Phone:770-683-0250
Practice Address - Fax:770-683-4250
Is Sole Proprietor?:No
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT007157225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist