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NPI Code Detail

MEDICARE: KENDALL MAYFIELD

MEDICARE: KENDALL MAYFIELD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist267546KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1M12-283-706OTHERKYDRIVERS LICENSE

General Provider Information

NPI Number : 1568050524
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENDALL MAYFIELD
Provider Business Mailing Address
First Line : 1901 COMMONWEALTH CT STE B
Second Line :
City : LOUISVILLE
State : KY
Zip : 40299-2355
Country : US
Telephone Number : 502-458-9978
Fax Number :
Provider Business Practice Location Address
First Line : 1901 COMMONWEALTH CT STE B
Second Line :
City : LOUISVILLE
State : KY
Zip : 40299-2355
Country : US
Telephone Number : 502-458-9978
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2021
Last Update Date : 01/05/2021

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Directions to “ KENDALL MAYFIELD ” Practice Location

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