Provider Demographics
NPI:1437215589
Name:ALLEN, KEVIN SHANE (ATC)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:SHANE
Last Name:ALLEN
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 1:1863 BRATTLEBORO CT APT D
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45440-1739
Mailing Address - Country:US
Mailing Address - Phone:937-291-0529
Mailing Address - Fax:
Practice Address - Street 1:6601 CENTERVILLE BUSINESS PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:CENTERVILLE FINANCE
Practice Address - State:OH
Practice Address - Zip Code:45459-2691
Practice Address - Country:US
Practice Address - Phone:937-208-9356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH8022255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer