MEDICARE: KELLY RATH

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
1	235Z00000X	Speech-Language Pathologist	COND.2015346	OH

General Provider Information

NPI Number	:	1790154821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY RATH

Provider Business Mailing Address
First Line	:	18900 DETROIT EXT
Second Line	:	APT 407
City	:	LAKEWOOD
State	:	OH
Zip	:	44107-3255
Country	:	US
Telephone Number	:	865-679-8787
Fax Number	:

Provider Business Practice Location Address
First Line	:	3213 MONTCLAIR AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44109-4121
Country	:	US
Telephone Number	:	216-741-1138
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/18/2015
Last Update Date	:	09/18/2015

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Directions to “ KELLY RATH ” Practice Location

Language	Start Address	Practice Location

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