Provider Demographics
NPI:1407979354
Name:MUNCY, BRENDA SUE (IECE)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:SUE
Last Name:MUNCY
Suffix:
Gender:F
Credentials:IECE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 GRAND VIEW DR
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-6739
Mailing Address - Country:US
Mailing Address - Phone:606-843-2577
Mailing Address - Fax:606-843-9459
Practice Address - Street 1:183 GRAND VIEW DR
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-6739
Practice Address - Country:US
Practice Address - Phone:606-843-2577
Practice Address - Fax:606-843-9459
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY200009896222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist