Provider Demographics
NPI:1063843548
Name:GEARY, KERRY (ATC)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:GEARY
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 WILMORE RD
Mailing Address - Street 2:WEST JESSAMINE HIGH SCHOOL
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-8917
Mailing Address - Country:US
Mailing Address - Phone:859-887-2421
Mailing Address - Fax:859-887-8854
Practice Address - Street 1:2101 WILMORE RD
Practice Address - Street 2:WEST JESSAMINE HIGH SCHOOL
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-8917
Practice Address - Country:US
Practice Address - Phone:859-887-2421
Practice Address - Fax:859-887-8854
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-09
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAT056174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist