Basic Information
Provider Information
NPI: 1922055813
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KOPAY-GUEVARA
FirstName: KATHLEEN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: AU. D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1912 THESY DR
Address2:  
City: VIERA
State: FL
PostalCode: 329406837
CountryCode: US
TelephoneNumber: 3216373788
FaxNumber:  
Practice Location
Address1: 2900 VETERANS WAY
Address2:  
City: VIERA
State: FL
PostalCode: 329408007
CountryCode: US
TelephoneNumber: 3216373788
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/27/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
231H00000XAY926FLY Speech, Language and Hearing Service ProvidersAudiologist 

No ID Information.


Home