Provider Demographics
NPI:1649514399
Name:SCARBERRY, KELLY
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:SCARBERRY
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 1:953 REYNOLDS CIR
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-3485
Mailing Address - Country:US
Mailing Address - Phone:419-698-5839
Mailing Address - Fax:
Practice Address - Street 1:28546 STARBRIGHT BLVD
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-4686
Practice Address - Country:US
Practice Address - Phone:419-666-0935
Practice Address - Fax:419-666-5610
Is Sole Proprietor?:No
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH009954225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist