Provider Demographics
NPI:1063904548
Name:SIMANSKI, KELSY MARIE (OTD, OTR)
Entity type:Individual
Prefix:
First Name:KELSY
Middle Name:MARIE
Last Name:SIMANSKI
Suffix:
Gender:F
Credentials:OTD, OTR
Other - Prefix:
Other - First Name:KELSY
Other - Middle Name:MARIE
Other - Last Name:TRACEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:124 HAWTHORNE LN
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-9430
Mailing Address - Country:US
Mailing Address - Phone:317-332-9861
Mailing Address - Fax:317-893-4453
Practice Address - Street 1:12860 MILTON RD
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-6415
Practice Address - Country:US
Practice Address - Phone:260-668-4277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-31
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99086161A225X00000X
IN31006653A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist