MEDICARE: MRS. SARAH CHINELLE GREEN COMETOLOGIST

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	332B00000X	Durable Medical Equipment & Medical Supplies	206490	KY

General Provider Information

NPI Number	:	1790247823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SARAH CHINELLE GREEN COMETOLOGIST

Provider Business Mailing Address
First Line	:	3402 BROOKHOLLOW DR
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40220-5006
Country	:	US
Telephone Number	:	502-533-2799
Fax Number	:

Provider Business Practice Location Address
First Line	:	3402 BROOKHOLLOW DR
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40220-5006
Country	:	US
Telephone Number	:	502-533-2799
Fax Number	:

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

Provider Enumeration Date	:	04/06/2019
Last Update Date	:	04/04/2025

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