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General NPI Number Information
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NPI Number | 1699213314
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Entity Type | Individual
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Provider Name | KEN MAYNELL
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Gender | Male
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Dates
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Enumeration Date | 02/01/2017
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Last Update Date | 02/01/2017
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Provider Practice Location Address
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Address Line | 13123 E 16TH AVE
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City | AURORA
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State | CO
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Zip | 80045-7106
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Country | US
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Telephone | 720-777-6645
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Fax | 720-777-6563
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Provider Business Mailing Address
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Address Line | 3615 MARTIN LUTHER KING BLVD
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City | DENVER
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State | CO
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Zip | 80205-4976
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Country | US
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Telephone | 720-777-6645
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Fax | 720-777-6563
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OTA.0000752
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License Number State | CO
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