Provider Demographics
NPI:1275885733
Name:MARKWELL, MONTY
Entity Type:Individual
Prefix:MR
First Name:MONTY
Middle Name:
Last Name:MARKWELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 OLD US HIGHWAY 60
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-7932
Mailing Address - Country:US
Mailing Address - Phone:606-776-5431
Mailing Address - Fax:
Practice Address - Street 1:290 COOK BR
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-9784
Practice Address - Country:US
Practice Address - Phone:606-776-5431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-09
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No174H00000XOther Service ProvidersHealth Educator