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NPI Code Detail

MEDICARE: HAYLY KENNEDY

MEDICARE: HAYLY KENNEDY
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
1224Z00000XOccupational Therapy Assistant4853-027WI

General Provider Information

NPI Number : 1255618229
Entity Type Code : Individual
Provider Name (Legal Business Name) : HAYLY KENNEDY
Provider Business Mailing Address
First Line : 13415 W FOUNTAIN DR APT 208
Second Line :
City : NEW BERLIN
State : WI
Zip : 53151-3994
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : W76N677 WAUWATOSA RD
Second Line :
City : CEDARBURG
State : WI
Zip : 53012-1707
Country : US
Telephone Number : 262-377-5060
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/04/2011
Last Update Date : 11/04/2011

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