Healthcare Provider Details

I. General information

NPI: 1144574666
Provider Name (Legal Business Name): CHIFFON RENA SRYGLER IECE/MASTERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2012
Last Update Date: 05/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 PRICEVILLE RD
BONNIEVILLE KY
42713
US

IV. Provider business mailing address

200 PRICEVILLE RD
BONNIEVILLE KY
42713-8448
US

V. Phone/Fax

Practice location:
  • Phone: 270-531-3987
  • Fax: 844-688-4227
Mailing address:
  • Phone: 270-531-3987
  • Fax: 844-688-4227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number000060968
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: