MEDICARE: MARY LOUISE KEMP

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1225305972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY LOUISE KEMP

Provider Business Mailing Address
First Line	:	2710 DEER HAVEN DR
Second Line	:
City	:	NORTHPORT
State	:	AL
Zip	:	35473-3048
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2710 DEER HAVEN DR
Second Line	:
City	:	NORTHPORT
State	:	AL
Zip	:	35473-3048
Country	:	US
Telephone Number	:	205-292-4998
Fax Number	:	205-333-9163

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

Provider Enumeration Date	:	11/23/2011
Last Update Date	:	11/23/2011

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Directions to “ MARY LOUISE KEMP ” Practice Location

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