Provider Demographics
NPI:1699550228
Name:RODRIGUEZ, KELSEA (OT)
Entity type:Individual
Prefix:
First Name:KELSEA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:KELSEA
Other - Middle Name:
Other - Last Name:KASAVAGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20057 BALATA DR
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-5459
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1601 CENTRAL AVE W
Practice Address - Street 2:
Practice Address - City:WIGGINS
Practice Address - State:MS
Practice Address - Zip Code:39577-2401
Practice Address - Country:US
Practice Address - Phone:601-716-3196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist