Provider Demographics
NPI:1730746116
Name:EDWARDS, KELSEY PAYGE (ATC)
Entity type:Individual
Prefix:MISS
First Name:KELSEY
Middle Name:PAYGE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5125 20TH ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61109-3803
Mailing Address - Country:US
Mailing Address - Phone:815-871-3543
Mailing Address - Fax:
Practice Address - Street 1:5125 20TH ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61109-3803
Practice Address - Country:US
Practice Address - Phone:815-871-3543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer