Provider Demographics
NPI:1730563933
Name:POTTS, KELSEY
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:POTTS
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 1:1051 SOUTHERN DR.
Mailing Address - Street 2:1207
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-4972
Mailing Address - Country:US
Mailing Address - Phone:214-519-4524
Mailing Address - Fax:
Practice Address - Street 1:1051 SOUTHERN DR
Practice Address - Street 2:1207
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-5189
Practice Address - Country:US
Practice Address - Phone:214-519-4524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-17
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer