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NPI Code Detail

MEDICARE: KAELEANN M MCCOY

MEDICARE:   KAELEANN M MCCOY
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1295322659
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAELEANN M MCCOY
Provider Business Mailing Address
First Line : 273 INDIAN VALLEY DR
Second Line :
City : KENT
State : OH
Zip : 44240-4431
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 273 INDIAN VALLEY DR
Second Line :
City : KENT
State : OH
Zip : 44240-4431
Country : US
Telephone Number : 330-541-0266
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/30/2020
Last Update Date : 12/30/2020

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Directions to “ KAELEANN M MCCOY ” Practice Location

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