Provider Demographics
NPI:1548627623
Name:YARBERRY, KELSEY (OTR/L)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:YARBERRY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:IN
Mailing Address - Zip Code:47250-2135
Mailing Address - Country:US
Mailing Address - Phone:812-265-8226
Mailing Address - Fax:812-265-8227
Practice Address - Street 1:2420 WILSON AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250-2135
Practice Address - Country:US
Practice Address - Phone:812-265-8226
Practice Address - Fax:812-265-8227
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225XP0200X
IN31007222A225XP0200X
KYBOTOCT00215829225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics