Provider Demographics
NPI:1104307487
Name:SEWARD, KELSEY GRACE (MS OTR/L)
Entity type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:GRACE
Last Name:SEWARD
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:MISS
Other - First Name:KELSEY
Other - Middle Name:GRACE
Other - Last Name:ZAWODZINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS OTR/L
Mailing Address - Street 1:142 AUTUMNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14227-2607
Mailing Address - Country:US
Mailing Address - Phone:716-359-2461
Mailing Address - Fax:
Practice Address - Street 1:3767 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-1040
Practice Address - Country:US
Practice Address - Phone:716-874-6175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021671-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist