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NPI Code Detail

MEDICARE: MRS. EMILY ELIZABETH DIVERS MA

MEDICARE: MRS. EMILY ELIZABETH DIVERS MA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist12514OH

General Provider Information

NPI Number : 1205349024
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. EMILY ELIZABETH DIVERS MA
Provider Business Mailing Address
First Line : 4210 TELEGRAPH LN
Second Line :
City : VERMILION
State : OH
Zip : 44089-3748
Country : US
Telephone Number : 440-967-1800
Fax Number :
Provider Business Practice Location Address
First Line : 4210 TELEGRAPH LN
Second Line :
City : VERMILION
State : OH
Zip : 44089-3748
Country : US
Telephone Number : 440-967-1800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/15/2017
Last Update Date : 11/15/2017

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Directions to “ MRS. EMILY ELIZABETH DIVERS MA” Practice Location

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