Provider Demographics
NPI:1407663958
Name:ELLIS, KELSEY ANN MCFARLAND (CTRS)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:ANN MCFARLAND
Last Name:ELLIS
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:ANN
Other - Last Name:MCFARLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CTRS
Mailing Address - Street 1:37526 SE FURY ST
Mailing Address - Street 2:
Mailing Address - City:SNOQUALMIE
Mailing Address - State:WA
Mailing Address - Zip Code:98065-9593
Mailing Address - Country:US
Mailing Address - Phone:360-621-9337
Mailing Address - Fax:
Practice Address - Street 1:9801 FRONTIER AVE SE
Practice Address - Street 2:
Practice Address - City:SNOQUALMIE
Practice Address - State:WA
Practice Address - Zip Code:98065-5200
Practice Address - Country:US
Practice Address - Phone:425-831-3761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA56429225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WARE60050280OtherWASHINGTON STATE DEPARTMENT OF HEALTH
56429OtherNCTRC