Provider Demographics
NPI:1154741429
Name:HENNESSEY, KELSIE T (MSED, ATC)
Entity type:Individual
Prefix:
First Name:KELSIE
Middle Name:T
Last Name:HENNESSEY
Suffix:
Gender:F
Credentials:MSED, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 COURT STREET
Mailing Address - Street 2:ORTHOPAEDICS
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431
Mailing Address - Country:US
Mailing Address - Phone:802-379-0131
Mailing Address - Fax:
Practice Address - Street 1:580 COURT STREET
Practice Address - Street 2:ORTHOPAEDICS
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431
Practice Address - Country:US
Practice Address - Phone:802-379-0131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-24
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH05322255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer