Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1033575667 |
---|---|
Provider Name | Kelsey Rochelle Ahlvers |
First Address | Spring Creek, NV 89815-5337 |
Second Address | Spring Creek, NV 89815-5337 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2016 |
Last Update Date | 12/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1780936435 | (05) | NV |