Provider Demographics
NPI:1760898852
Name:BLOOD, KENNETH (ATC)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:BLOOD
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 1:53 N LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:NEW CONCORD
Mailing Address - State:OH
Mailing Address - Zip Code:43762-9791
Mailing Address - Country:US
Mailing Address - Phone:740-260-3590
Mailing Address - Fax:740-826-6123
Practice Address - Street 1:163 STORMONT ST
Practice Address - Street 2:
Practice Address - City:NEW CONCORD
Practice Address - State:OH
Practice Address - Zip Code:43762-1118
Practice Address - Country:US
Practice Address - Phone:740-826-8327
Practice Address - Fax:740-826-6123
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH172255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer