Healthcare Provider Details

I. General information

NPI: 1134730948
Provider Name (Legal Business Name): CHRISTOPHER JOHN KENNEDY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2020
Last Update Date: 08/14/2020
Certification Date: 08/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6678 SPRINGDALE DR
CLEVELAND OH
44130-2600
US

IV. Provider business mailing address

6678 SPRINGDALE DR
CLEVELAND OH
44130-2600
US

V. Phone/Fax

Practice location:
  • Phone: 216-408-2880
  • Fax:
Mailing address:
  • Phone: 216-408-2880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number139179
License Number State
# 2
Primary TaxonomyN
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License NumberRCP.13501
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: