Provider Demographics
NPI:1295226074
Name:KENNEDY, ASHLEY MAY (ATC)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MAY
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 FOXCROFT RD
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-2430
Mailing Address - Country:US
Mailing Address - Phone:860-394-8092
Mailing Address - Fax:
Practice Address - Street 1:27 FOXCROFT RD
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-2430
Practice Address - Country:US
Practice Address - Phone:860-394-8092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-28
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT13432255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer