Provider Demographics
NPI:1386817336
Name:WHEATLEY, KERR SCOTT (CP)
Entity Type:Individual
Prefix:
First Name:KERR
Middle Name:SCOTT
Last Name:WHEATLEY
Suffix:
Gender:M
Credentials:CP
Other - Prefix:
Other - First Name:SCOTT
Other - Middle Name:
Other - Last Name:WHEATLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:411 BILLINGSLEY RD STE 104
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-1066
Mailing Address - Country:US
Mailing Address - Phone:407-377-7099
Mailing Address - Fax:
Practice Address - Street 1:411 BILLINGSLEY RD STE 104
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1066
Practice Address - Country:US
Practice Address - Phone:407-377-7099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist