Provider Demographics
NPI:1487881793
Name:MEYERS, KELLY A
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:A
Last Name:MEYERS
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 1:5199 STATE HIGHWAY 8
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:NY
Mailing Address - Zip Code:13411-3503
Mailing Address - Country:US
Mailing Address - Phone:607-847-9744
Mailing Address - Fax:
Practice Address - Street 1:5199 STATE HIGHWAY 8
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:NY
Practice Address - Zip Code:13411-3503
Practice Address - Country:US
Practice Address - Phone:607-847-9744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-12
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007554-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist