Provider Demographics
NPI:1285373902
Name:SEEROCKERS, KELSEY E (OTD)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:E
Last Name:SEEROCKERS
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:E
Other - Last Name:RANNEKLEV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTD
Mailing Address - Street 1:2121 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:ALBERT LEA
Mailing Address - State:MN
Mailing Address - Zip Code:56007-2007
Mailing Address - Country:US
Mailing Address - Phone:630-200-8274
Mailing Address - Fax:
Practice Address - Street 1:2121 GRAND AVE
Practice Address - Street 2:
Practice Address - City:ALBERT LEA
Practice Address - State:MN
Practice Address - Zip Code:56007-2007
Practice Address - Country:US
Practice Address - Phone:630-200-8274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-01
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.015452225X00000X
225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist