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General NPI Number Information
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NPI Number | 1285054957
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Entity Type | Individual
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Provider Name | KELLY CANTERBURY
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Gender | Female
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Dates
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Enumeration Date | 04/22/2014
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Last Update Date | 04/22/2014
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Provider Practice Location Address
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Address Line | 5004 GLAZIER AVE
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City | CLEVELAND
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State | OH
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Zip | 44127-1111
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Country | US
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Telephone | 216-883-6118
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Fax |
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Provider Business Mailing Address
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Address Line | 4010 BOXELDER DR
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City | MEDINA
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State | OH
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Zip | 44256-7017
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Country | US
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Telephone | 440-309-5123
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SP7783
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License Number State | OH
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