Provider Demographics
NPI:1063945699
Name:BUSH, KELSEY (OTR/L)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:BUSH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 GREEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:VA
Mailing Address - Zip Code:24266-6161
Mailing Address - Country:US
Mailing Address - Phone:276-591-9922
Mailing Address - Fax:
Practice Address - Street 1:238 GREEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:VA
Practice Address - Zip Code:24266-6161
Practice Address - Country:US
Practice Address - Phone:276-591-9922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-10
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119007312225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist