MEDICARE: MR. KENNY D MAYNES OTR/L, CHT

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	225X00000X	Occupational Therapist	134170	KY
2	225XE1200X	Ergonomics Occupational Therapist	134170	KY
3	225XH1200X	Hand Occupational Therapist	134170	KY

General Provider Information

NPI Number	:	1932376175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KENNY D MAYNES OTR/L, CHT

Provider Business Mailing Address
First Line	:	1400 CUMBERLAND FALLS HWY STE C
Second Line	:
City	:	CORBIN
State	:	KY
Zip	:	40701-2739
Country	:	US
Telephone Number	:	606-528-2149
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 CUMBERLAND FALLS HWY STE C
Second Line	:
City	:	CORBIN
State	:	KY
Zip	:	40701-2739
Country	:	US
Telephone Number	:	606-528-2149
Fax Number	:	606-528-2338

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

Provider Enumeration Date	:	05/15/2008
Last Update Date	:	03/17/2025

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