Healthcare Provider Details

I. General information

NPI: 1477932309
Provider Name (Legal Business Name): KELLI KAZMAIER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2015
Last Update Date: 05/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 STAUNTON RD
TROY OH
45373-1451
US

IV. Provider business mailing address

1974 WOODBINE CT
TROY OH
45373-9277
US

V. Phone/Fax

Practice location:
  • Phone: 937-332-6006
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberOH1160906
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: