Provider Demographics
NPI:1578574810
Name:DWYER-KELLY, AMY S (BS)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:S
Last Name:DWYER-KELLY
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1565 SCHOOLCRAFT AVE
Mailing Address - Street 2:
Mailing Address - City:COPLEY
Mailing Address - State:OH
Mailing Address - Zip Code:44321-2028
Mailing Address - Country:US
Mailing Address - Phone:330-858-8530
Mailing Address - Fax:330-858-8530
Practice Address - Street 1:807 LAWN AVE
Practice Address - Street 2:
Practice Address - City:SELLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18960-1549
Practice Address - Country:US
Practice Address - Phone:215-257-6551
Practice Address - Fax:215-453-5181
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist