Provider Demographics
NPI:1538570247
Name:FROESE, KELLEY
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:
Last Name:FROESE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 E 56TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67502-8209
Mailing Address - Country:US
Mailing Address - Phone:620-899-9610
Mailing Address - Fax:
Practice Address - Street 1:108 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:INMAN
Practice Address - State:KS
Practice Address - Zip Code:67546-8016
Practice Address - Country:US
Practice Address - Phone:620-712-1041
Practice Address - Fax:620-712-1043
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST-03810224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant