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NPI Code Detail

MEDICARE: KENNEDY COOK RBT

MEDICARE: KENNEDY COOK RBT
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
1106S00000XBehavior TechnicianRBT-19-107937OK

General Provider Information

NPI Number : 1750993721
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENNEDY COOK RBT
Provider Business Mailing Address
First Line : 3005 SW PARK AVE
Second Line :
City : LAWTON
State : OK
Zip : 73505-7902
Country : US
Telephone Number : 580-699-5558
Fax Number : 580-699-5559
Provider Business Practice Location Address
First Line : 3005 SW PARK AVE
Second Line :
City : LAWTON
State : OK
Zip : 73505-7902
Country : US
Telephone Number : 580-699-5558
Fax Number : 580-699-5559
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/20/2020
Last Update Date : 08/20/2020

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Directions to “ KENNEDY COOK RBT” Practice Location

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