Provider Demographics
NPI:1891012704
Name:KENNY, KAY ELIZABETH (PTA)
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:ELIZABETH
Last Name:KENNY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 CREAMERY RD
Mailing Address - Street 2:
Mailing Address - City:ELVERSON
Mailing Address - State:PA
Mailing Address - Zip Code:19520-9009
Mailing Address - Country:US
Mailing Address - Phone:484-798-5576
Mailing Address - Fax:
Practice Address - Street 1:171 CREAMERY RD
Practice Address - Street 2:
Practice Address - City:ELVERSON
Practice Address - State:PA
Practice Address - Zip Code:19520-9009
Practice Address - Country:US
Practice Address - Phone:484-798-5576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-01
Last Update Date:2010-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE005132L171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor