Provider Demographics
NPI:1851624746
Name:OVERCASHER, KELLY R (AUD, CCC-A,)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:R
Last Name:OVERCASHER
Suffix:
Gender:F
Credentials:AUD, CCC-A,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6647 FRANK AVE NW
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-7259
Mailing Address - Country:US
Mailing Address - Phone:330-494-8348
Mailing Address - Fax:330-494-8356
Practice Address - Street 1:6647 FRANK AVE NW
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-7259
Practice Address - Country:US
Practice Address - Phone:330-494-8348
Practice Address - Fax:330-494-8356
Is Sole Proprietor?:No
Enumeration Date:2009-09-10
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH237600000X, 237700000X, 237600000X
OHA01712231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH400830OtherMEDICARE