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NPI Code Detail

MEDICARE: MRS. NICOLE GERMAINE KENYON OTR/L

MEDICARE: MRS. NICOLE GERMAINE KENYON OTR/L
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
1225X00000XOccupational Therapist8653MA

General Provider Information

NPI Number : 1396917803
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. NICOLE GERMAINE KENYON OTR/L
Provider Business Mailing Address
First Line : 500 WILBUR AVE
Second Line :
City : SOMERSET
State : MA
Zip : 02725-2051
Country : US
Telephone Number : 508-675-7589
Fax Number :
Provider Business Practice Location Address
First Line : 500 WILBUR AVE
Second Line :
City : SOMERSET
State : MA
Zip : 02725-2051
Country : US
Telephone Number : 508-675-7589
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/25/2008
Last Update Date : 03/25/2008

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Directions to “ MRS. NICOLE GERMAINE KENYON OTR/L” Practice Location

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