MEDICARE: KENNETH WAYNE COLLIER JR.

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	146L00000X	Paramedic	114336	OH

General Provider Information

NPI Number	:	1134808272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH WAYNE COLLIER JR.

Provider Business Mailing Address
First Line	:	PO BOX 13353
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45413-0353
Country	:	US
Telephone Number	:	937-672-0894
Fax Number	:

Provider Business Practice Location Address
First Line	:	2554 NEEDMORE RD # C2
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45414-4204
Country	:	US
Telephone Number	:	937-672-0894
Fax Number	:

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

Provider Enumeration Date	:	07/17/2023
Last Update Date	:	07/17/2023

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