Individual
KELSEY TYSICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
2701 CHESTNUT STATION CT, LOUISVILLE, KY 40299-6395
(800) 335-1060
Mailing address
3802 JONES RD, NORTH BRANCH, MI 48461-8930
(810) 969-5311
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5202008199
MI
Other
Enumeration date
03/20/2019
Last updated
03/20/2019
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