Healthcare Provider Details

I. General information

NPI: 1932376175
Provider Name (Legal Business Name): KENNY D MAYNES OTR/L, CHT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2008
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 CUMBERLAND FALLS HWY STE C
CORBIN KY
40701-2739
US

IV. Provider business mailing address

1400 CUMBERLAND FALLS HWY STE C
CORBIN KY
40701-2739
US

V. Phone/Fax

Practice location:
  • Phone: 606-528-2149
  • Fax: 606-528-2338
Mailing address:
  • Phone: 606-528-2149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number134170
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code225XE1200X
TaxonomyErgonomics Occupational Therapist
License Number134170
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number134170
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: