MEDICARE: DR. LEAH MICHELLE KELLY CCC-SLP, AUD

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	231H00000X	Audiologist	A2434	MS

General Provider Information

NPI Number	:	1023247657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEAH MICHELLE KELLY CCC-SLP, AUD

Provider Business Mailing Address
First Line	:	6104 LINDHOLM DR
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36693-3732
Country	:	US
Telephone Number	:	251-367-8627
Fax Number	:

Provider Business Practice Location Address
First Line	:	6104 LINDHOLM DR
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36693-3732
Country	:	US
Telephone Number	:	251-367-8627
Fax Number	:

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

Provider Enumeration Date	:	07/02/2009
Last Update Date	:	07/02/2009

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