Provider Demographics
NPI:1104692805
Name:SARDINSKAS, KELSEY LYNNE (OT)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:LYNNE
Last Name:SARDINSKAS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:LYNNE
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:555 AUBURN ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-4803
Mailing Address - Country:US
Mailing Address - Phone:603-621-3516
Mailing Address - Fax:
Practice Address - Street 1:435 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-4841
Practice Address - Country:US
Practice Address - Phone:603-666-5982
Practice Address - Fax:603-621-3492
Is Sole Proprietor?:No
Enumeration Date:2023-12-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3484225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist