Provider Demographics
NPI:1629263207
Name:ELIZABETH C. GAMIEL
Entity Type:Organization
Organization Name:ELIZABETH C. GAMIEL
Other - Org Name:KEG THERAPIES, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:CLONINGER
Authorized Official - Last Name:GAMIEL
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:252-473-2733
Mailing Address - Street 1:951 US HIGHWAY 64
Mailing Address - Street 2:
Mailing Address - City:MANTEO
Mailing Address - State:NC
Mailing Address - Zip Code:27954-9537
Mailing Address - Country:US
Mailing Address - Phone:252-473-2733
Mailing Address - Fax:252-473-6733
Practice Address - Street 1:951 US HIGHWAY 64
Practice Address - Street 2:
Practice Address - City:MANTEO
Practice Address - State:NC
Practice Address - Zip Code:27954-9537
Practice Address - Country:US
Practice Address - Phone:252-473-2733
Practice Address - Fax:252-473-6733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7212018Medicaid