Provider Demographics
NPI:1437415098
Name:OWEN, KELSIE LOREHA (ATC/L)
Entity type:Individual
Prefix:
First Name:KELSIE
Middle Name:LOREHA
Last Name:OWEN
Suffix:
Gender:F
Credentials:ATC/L
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 22520
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98907-2520
Mailing Address - Country:US
Mailing Address - Phone:509-574-6822
Mailing Address - Fax:509-574-4732
Practice Address - Street 1:1107 S 16TH AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-5331
Practice Address - Country:US
Practice Address - Phone:509-574-6822
Practice Address - Fax:509-574-4732
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAA1600473382255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer