Healthcare Provider Details

I. General information

NPI: 1629898416
Provider Name (Legal Business Name): MAKENZIE SCRIBANO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2024
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4011 RUBY ROSE RD
RICHMOND KY
40475-8429
US

IV. Provider business mailing address

3129 DEPOT ST
RICHMOND KY
40475-9458
US

V. Phone/Fax

Practice location:
  • Phone: 270-860-9594
  • Fax:
Mailing address:
  • Phone: 859-661-9151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: