Individual
KELSEA SHEA NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5050 LINCOLN AVE, EVANSVILLE, IN 47715-7390
(812) 303-7245
(812) 303-7346
Mailing address
655 COUNTY ROAD 725 E, NORRIS CITY, IL 62869-3709
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057004601
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
057004601
ILLINOIS LICENSE
IL
Enumeration date
06/01/2017
Last updated
09/25/2021
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