Provider Demographics
NPI:1083436448
Name:SCHAU, KELLY
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:SCHAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 MAPLE LN
Mailing Address - Street 2:
Mailing Address - City:TORNADO
Mailing Address - State:WV
Mailing Address - Zip Code:25202-9729
Mailing Address - Country:US
Mailing Address - Phone:304-993-5721
Mailing Address - Fax:
Practice Address - Street 1:112 MAPLE LN
Practice Address - Street 2:
Practice Address - City:TORNADO
Practice Address - State:WV
Practice Address - Zip Code:25202-9729
Practice Address - Country:US
Practice Address - Phone:304-993-5721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency