MEDICARE: KENNETH WEYRAUCH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376J00000X	Homemaker

General Provider Information

NPI Number	:	1013512466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH WEYRAUCH

Provider Business Mailing Address
First Line	:	1102 TOWNSHIP ROAD 267
Second Line	:
City	:	AMSTERDAM
State	:	OH
Zip	:	43903-7913
Country	:	US
Telephone Number	:	740-543-4316
Fax Number	:

Provider Business Practice Location Address
First Line	:	1102 TOWNSHIP ROAD 267
Second Line	:
City	:	AMSTERDAM
State	:	OH
Zip	:	43903-7913
Country	:	US
Telephone Number	:	740-543-4316
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/03/2020
Last Update Date	:	12/03/2020

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Directions to “ KENNETH WEYRAUCH ” Practice Location

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