Provider Demographics
NPI:1760054456
Name:CHAMBERS, KENNETH LLEWELLYN III
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:LLEWELLYN
Last Name:CHAMBERS
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 1:9611 E IDLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TWINSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44087-1684
Mailing Address - Country:US
Mailing Address - Phone:440-789-6115
Mailing Address - Fax:
Practice Address - Street 1:17134 LORAIN AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-5515
Practice Address - Country:US
Practice Address - Phone:216-242-6366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-13
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1744P3200X
OH17600544561744P3200X, 224P00000X
OH224P00000X, 1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty
No1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Multi-Specialty