MEDICARE: MRS. CHRISTINE KENYON

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	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1568350445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHRISTINE KENYON

Provider Business Mailing Address
First Line	:	1 LEO MOSS DR DEPT OF
Second Line	:
City	:	OLEAN
State	:	NY
Zip	:	14760-1100
Country	:	US
Telephone Number	:	716-938-2472
Fax Number	:

Provider Business Practice Location Address
First Line	:	207 ROCK CITY ST
Second Line	:
City	:	LITTLE VALLEY
State	:	NY
Zip	:	14755-1267
Country	:	US
Telephone Number	:	716-938-2472
Fax Number	:	716-701-3750

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

Provider Enumeration Date	:	06/27/2025
Last Update Date	:	06/27/2025

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