Basic Information
| Provider Information | |||||||||
| NPI: | 1215527312 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SEIVERS | ||||||||
| FirstName: | KELBY | ||||||||
| MiddleName: | JOY | ||||||||
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| Credential: | MA, CF-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1937 SHROUD ST UNIT 103 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328146910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4237676180 | ||||||||
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| Practice Location | |||||||||
| Address1: | 756 N SUN DR | ||||||||
| Address2: | |||||||||
| City: | LAKE MARY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327462507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4078523300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2021 | ||||||||
| LastUpdateDate: | 01/22/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | FL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | SZ9942 | FL | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.