Provider Demographics
NPI:1770179111
Name:MENTZEL, KEN SR
Entity Type:Individual
Prefix:
First Name:KEN
Middle Name:
Last Name:MENTZEL
Suffix:SR
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 1:8279 MEADOWLARK DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-6804
Mailing Address - Country:US
Mailing Address - Phone:513-349-9974
Mailing Address - Fax:
Practice Address - Street 1:8279 MEADOWLARK DR
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-6804
Practice Address - Country:US
Practice Address - Phone:513-349-9974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-20
Last Update Date:2020-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant