Healthcare Provider Details

I. General information

NPI: 1275885733
Provider Name (Legal Business Name): MR. MONTY MARKWELL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2012
Last Update Date: 02/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 COOK BR
MOREHEAD KY
40351-9784
US

IV. Provider business mailing address

365 OLD US HIGHWAY 60
MOREHEAD KY
40351-7932
US

V. Phone/Fax

Practice location:
  • Phone: 606-776-5431
  • Fax:
Mailing address:
  • Phone: 606-776-5431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: