Provider Demographics
NPI:1063898641
Name:CARTER, KELSIE A
Entity type:Individual
Prefix:
First Name:KELSIE
Middle Name:A
Last Name:CARTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:292 LONE LINE RD
Mailing Address - Street 2:
Mailing Address - City:OAKESDALE
Mailing Address - State:WA
Mailing Address - Zip Code:99158
Mailing Address - Country:US
Mailing Address - Phone:509-499-6980
Mailing Address - Fax:
Practice Address - Street 1:292 LONE LINE RD
Practice Address - Street 2:
Practice Address - City:OAKESDALE
Practice Address - State:WA
Practice Address - Zip Code:99158
Practice Address - Country:US
Practice Address - Phone:509-499-6980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-05
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT60369984225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist