Healthcare Provider Details

I. General information

NPI: 1508964073
Provider Name (Legal Business Name): KAI REBECCA KELMACHTER AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 06/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13800 VETERANS WAY
ORLANDO FL
32827-7403
US

IV. Provider business mailing address

10652 TIBBETT ST
ORLANDO FL
32832-4985
US

V. Phone/Fax

Practice location:
  • Phone: 407-631-1100
  • Fax:
Mailing address:
  • Phone: 617-710-2362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberSP845-AU
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: