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NPI Code Detail

MEDICARE: ANTHONY KENNEDY

MEDICARE: ANTHONY 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
1225X00000XOccupational TherapistOT - 1570ID

General Provider Information

NPI Number : 1538528708
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANTHONY KENNEDY
Provider Business Mailing Address
First Line : 115 BREWSTER ST W
Second Line :
City : HARVEY
State : ND
Zip : 58341-1518
Country : US
Telephone Number : 701-341-1569
Fax Number :
Provider Business Practice Location Address
First Line : 7211 W FRANKLIN RD
Second Line :
City : BOISE
State : ID
Zip : 83709-0926
Country : US
Telephone Number : 701-341-1569
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/16/2016
Last Update Date : 02/16/2016

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