Provider Demographics
NPI:1629492780
Name:KEPES, KARY JAY
Entity Type:Individual
Prefix:
First Name:KARY JAY
Middle Name:
Last Name:KEPES
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 1:11170 CORY LANE
Mailing Address - Street 2:
Mailing Address - City:NEWBURY
Mailing Address - State:OH
Mailing Address - Zip Code:44065
Mailing Address - Country:US
Mailing Address - Phone:440-478-0842
Mailing Address - Fax:
Practice Address - Street 1:470 CENTER STREET
Practice Address - Street 2:2
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44065
Practice Address - Country:US
Practice Address - Phone:440-279-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-10
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02075225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant