Provider Demographics
NPI:1902439342
Name:FRISON, KELSEY LYNNE (OTRL)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:LYNNE
Last Name:FRISON
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 HUMBER DR APT E8
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-4932
Mailing Address - Country:US
Mailing Address - Phone:734-646-7198
Mailing Address - Fax:
Practice Address - Street 1:4731 TROUSDALE DR STE 12
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37220-1360
Practice Address - Country:US
Practice Address - Phone:615-832-8955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-13
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6425225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist