Provider Demographics
NPI:1497457907
Name:NOVOTH, KELLY
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:NOVOTH
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 1:47 REGINA DR
Mailing Address - Street 2:
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782-2429
Mailing Address - Country:US
Mailing Address - Phone:631-766-1106
Mailing Address - Fax:
Practice Address - Street 1:600 S SERVICE RD
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-6015
Practice Address - Country:US
Practice Address - Phone:631-271-0777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist