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NPI Code Detail

MEDICARE: HEATHER KELLY

MEDICARE: HEATHER KELLY
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
1235Z00000XSpeech-Language Pathologist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1972078582
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEATHER KELLY
Provider Business Mailing Address
First Line : 1250 WINNOWING WAY UNIT 416
Second Line :
City : MOUNT PLEASANT
State : SC
Zip : 29466-7527
Country : US
Telephone Number : 860-919-5925
Fax Number :
Provider Business Practice Location Address
First Line : 2685 LEEDS AVE
Second Line :
City : NORTH CHARLESTON
State : SC
Zip : 29405-6861
Country : US
Telephone Number : 843-529-3130
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2018
Last Update Date : 10/10/2018

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Directions to “ HEATHER KELLY ” Practice Location

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