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General NPI Number Information
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NPI Number | 1508131020
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Entity Type | Individual
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Provider Name | KELLY MYERS GUYOT BCBA
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Gender | Female
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Dates
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Enumeration Date | 03/16/2012
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Last Update Date | 06/06/2015
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Provider Practice Location Address
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Address Line | 4900 W NORFOLK RD
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City | PORTSMOUTH
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State | VA
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Zip | 23703-2128
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Country | US
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Telephone | 757-404-1393
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Fax | 877-861-7359
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Provider Business Mailing Address
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Address Line | 4900 W NORFOLK RD
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City | PORTSMOUTH
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State | VA
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Zip | 23703-2128
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Country | US
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Telephone | 757-404-1393
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Fax | 877-861-7359
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-01-9925
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License Number State | VA
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