Provider Demographics
NPI:1750970224
Name:GANLEY, KATHY
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:GANLEY
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 1:1165 SOM CENTER RD APT 310
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2085
Mailing Address - Country:US
Mailing Address - Phone:970-390-4492
Mailing Address - Fax:
Practice Address - Street 1:1165 SOM CENTER RD APT 310
Practice Address - Street 2:
Practice Address - City:MAYFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44124-2085
Practice Address - Country:US
Practice Address - Phone:970-390-4492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No171W00000XOther Service ProvidersContractorGroup - Single Specialty