MEDICARE: MRS. MIRIAM GATES KERR MAT CCC SCP

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	235Z00000X	Speech-Language Pathologist	2202004153	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	41488	OTHER	VA	OPTIMA FAMILY CARE
2	48741	OTHER	NC	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	A4962	OTHER	NC	MEDCOST

General Provider Information

NPI Number	:	1881635894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MIRIAM GATES KERR MAT CCC SCP

Provider Business Mailing Address
First Line	:	1241 N MAIN ST
Second Line	:
City	:	HARRISONBURG
State	:	VA
Zip	:	22802
Country	:	US
Telephone Number	:	540-434-1941
Fax Number	:	540-433-8277

Provider Business Practice Location Address
First Line	:	1241 N MAIN ST
Second Line	:
City	:	HARRISONBURG
State	:	VA
Zip	:	22802
Country	:	US
Telephone Number	:	540-434-1941
Fax Number	:	540-433-8277

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

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	07/08/2007

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