Provider Demographics
NPI:1437313574
Name:MITCHELL, KERRY
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 WILDWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35670-3846
Mailing Address - Country:US
Mailing Address - Phone:256-350-8607
Mailing Address - Fax:
Practice Address - Street 1:500 SAINT CLAIR AVE SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5021
Practice Address - Country:US
Practice Address - Phone:256-539-5111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0837225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist