Provider Demographics
NPI:1962056416
Name:MCPHERSON, KELSEY MAE (OTRL)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:MAE
Last Name:MCPHERSON
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:494 W CENTRAL AVE OPTIONAL
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015
Mailing Address - Country:US
Mailing Address - Phone:740-369-3650
Mailing Address - Fax:
Practice Address - Street 1:494 W CENTRAL AVE OPTIONAL
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015
Practice Address - Country:US
Practice Address - Phone:740-369-3650
Practice Address - Fax:740-369-0812
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-01
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT10706225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHOT10706OtherSTATE LICENSE