Provider Demographics
NPI:1265530307
Name:KLAGES, MERYL J (ITDS)
Entity type:Individual
Prefix:MRS
First Name:MERYL
Middle Name:J
Last Name:KLAGES
Suffix:
Gender:F
Credentials:ITDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 SW 34TH TER
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-7823
Mailing Address - Country:US
Mailing Address - Phone:239-945-7671
Mailing Address - Fax:239-945-7240
Practice Address - Street 1:432 SW 34TH TER
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33914-7823
Practice Address - Country:US
Practice Address - Phone:239-945-7671
Practice Address - Fax:239-945-7240
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist