Healthcare Provider Details

I. General information

NPI: 1568350445
Provider Name (Legal Business Name): MRS. CHRISTINE KENYON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2025
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 ROCK CITY ST
LITTLE VALLEY NY
14755-1267
US

IV. Provider business mailing address

1 LEO MOSS DR DEPT OF
OLEAN NY
14760-1100
US

V. Phone/Fax

Practice location:
  • Phone: 716-938-2472
  • Fax: 716-701-3750
Mailing address:
  • Phone: 716-938-2472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: