Provider Demographics
NPI:1467686956
Name:SCHAEFER-KOTELES, MARY K (MS, CCC, SLP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:K
Last Name:SCHAEFER-KOTELES
Suffix:
Gender:F
Credentials:MS, CCC, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 LORRAINE RD
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02090-1040
Mailing Address - Country:US
Mailing Address - Phone:781-461-0267
Mailing Address - Fax:
Practice Address - Street 1:48 LORRAINE RD
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:MA
Practice Address - Zip Code:02090-1040
Practice Address - Country:US
Practice Address - Phone:781-461-0267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1863235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist