Provider Demographics
NPI:1437519220
Name:FOLLETT, KENNETH DAVID III
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:DAVID
Last Name:FOLLETT
Suffix:III
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 1:1487 STARK AVE NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49534-2270
Mailing Address - Country:US
Mailing Address - Phone:616-893-4327
Mailing Address - Fax:
Practice Address - Street 1:1487 STARK AVE NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49534-2270
Practice Address - Country:US
Practice Address - Phone:616-893-4327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-07
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer