Provider Demographics
NPI:1124882568
Name:WASHKO, KELSEY MOYRA (OTR/L)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:MOYRA
Last Name:WASHKO
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 1:11020 STONE RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44125-4757
Mailing Address - Country:US
Mailing Address - Phone:216-219-0659
Mailing Address - Fax:
Practice Address - Street 1:150 N MILLER ROAD
Practice Address - Street 2:SUITE 150A
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333
Practice Address - Country:US
Practice Address - Phone:216-219-0659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT012745225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist