Provider Demographics
NPI:1053955583
Name:LEE, KELSEY
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 101
Mailing Address - Street 2:
Mailing Address - City:FAULKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57438-0101
Mailing Address - Country:US
Mailing Address - Phone:605-277-5044
Mailing Address - Fax:
Practice Address - Street 1:318 11TH AVE S
Practice Address - Street 2:
Practice Address - City:FAULKTON
Practice Address - State:SD
Practice Address - Zip Code:57438-2185
Practice Address - Country:US
Practice Address - Phone:605-277-5044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist