Active NPI
Kelsea Shea Nelson
- Occupational Therapy Assistant
- Evansville, IN
National Provider Identifier
1033647185
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 057004601
- Practice address
- 5050 Lincoln Ave
Evansville, IN 47715-7390 - Phone
- (812) 303-7245
- Fax
- (812) 303-7346
- NPI assigned
- Jun 1, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 057004601 | IL | Primary |
Addresses
Primary practice location
5050 Lincoln Ave
Evansville, IN 47715-7390
Mailing address
655 County Road 725 E
Norris City, IL 62869-3709
Other practice location 1
216 College Blvd
Carmi, IL 62821-1548
Phone (618) 382-4644
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 057004601 | Other | IL | ILLINOIS LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 057004601 | IL | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1496275200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1632528000000",
"number": "1033647185",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "655 COUNTY ROAD 725 E",
"city": "NORRIS CITY",
"state": "IL",
"postal_code": "628693709"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5050 LINCOLN AVE",
"city": "EVANSVILLE",
"state": "IN",
"postal_code": "477157390",
"telephone_number": "812-303-7245",
"fax_number": "812-303-7346"
}
],
"practiceLocations": [
{
"address_1": "216 College Blvd",
"address_purpose": "LOCATION",
"city": "Carmi",
"state": "IL",
"postal_code": "628211548",
"country_code": "US",
"telephone_number": "618-382-4644",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "NELSON",
"first_name": "KELSEA",
"middle_name": "SHEA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-06-01",
"last_updated": "2021-09-25",
"certification_date": "2021-09-25",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "IL",
"license": "057004601",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ILLINOIS LICENSE",
"identifier": "057004601",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Evansville, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.