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General NPI Number Information
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NPI Number | 1306295340
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Entity Type | Organization
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Legal Business Name | GUYNN DEVELOPMENTAL INTERVENTION
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Dates
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Enumeration Date | 06/09/2016
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Last Update Date | 06/09/2016
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Provider Practice Location Address
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Address Line | 1520 BUNTIN LN
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City | MADISONVILLE
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State | KY
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Zip | 42431-2219
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Country | US
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Telephone | 270-871-8640
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Fax |
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Provider Business Mailing Address
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Address Line | 1520 BUNTIN LN
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City | MADISONVILLE
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State | KY
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Zip | 42431-2219
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DEVELOPMENTAL THERAPIST
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Name | ROBIN GUYNN
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Credential |
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Telephone | 270-871-8640
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 201135075
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License Number State | KY
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