Provider Demographics
NPI:1619628138
Name:EMODI, KENZIE ELIZABETH
Entity Type:Individual
Prefix:
First Name:KENZIE
Middle Name:ELIZABETH
Last Name:EMODI
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 1:2114 CHRISTINE ST
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68133-2386
Mailing Address - Country:US
Mailing Address - Phone:402-681-2883
Mailing Address - Fax:
Practice Address - Street 1:2114 CHRISTINE ST
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68133-2386
Practice Address - Country:US
Practice Address - Phone:402-681-2883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-17
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer