MEDICARE: MRS. KARLI IRENE DEMELL

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	175T00000X	Peer Specialist	00340	OH

General Provider Information

NPI Number	:	1023534138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KARLI IRENE DEMELL

Provider Business Mailing Address
First Line	:	PO BOX 1501
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44309-1501
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	885 EAST BUCHTEL AVENUE
Second Line	:	P.O. BOX 1501
City	:	AKRON
State	:	OH
Zip	:	44309
Country	:	US
Telephone Number	:	330-996-2222
Fax Number	:

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

Provider Enumeration Date	:	08/21/2017
Last Update Date	:	08/21/2017

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