Individual
KELSEY WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
960 CENTURY DR, MECHANICSBURG, PA 17055-4530
(717) 480-6785
Mailing address
960 CENTURY DR, MECHANICSBURG, PA 17055-4530
(717) 480-6785
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
225500000X
Respiratory/Developmental/Rehabilitative Specialist/Technologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100777740
—
PA
05
—
1029202560005
—
PA
Enumeration date
11/28/2016
Last updated
03/08/2017
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