Individual
KELLY L DURBIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A.,C.C.C.-A
Contact information
Practice address
25761 LORAIN RD, 3RD FL, NORTH OLMSTED, OH 44070-3327
(440) 779-1112
Mailing address
25761 LORAIN RD, 3RD FL, NORTH OLMSTED, OH 44070-3327
(440) 779-1112
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
A-01109
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0972309
—
OH
05
—
2085523
—
OH
05
—
2085541
—
OH
01
—
4246481
MEDICARE PTAN
OH
01
—
P00681443
MEDICARE RAILROAD PTAN
OH
Enumeration date
07/28/2008
Last updated
10/10/2014
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