MEDICARE: KEVIN FRACTION

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
1	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1871895896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN FRACTION

Provider Business Mailing Address
First Line	:	8025 W RUSSELL RD
Second Line	:	ST #2106
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-1579
Country	:	US
Telephone Number	:	414-702-9721
Fax Number	:

Provider Business Practice Location Address
First Line	:	8025 W RUSSELL RD
Second Line	:	ST #2106
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-1579
Country	:	US
Telephone Number	:	414-702-9721
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/23/2010
Last Update Date	:	12/16/2010

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Directions to “ KEVIN FRACTION ” Practice Location

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