Provider Demographics
NPI:1013512466
Name:WEYRAUCH, KENNETH
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:WEYRAUCH
Suffix:
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 1:1102 TOWNSHIP ROAD 267
Mailing Address - Street 2:
Mailing Address - City:AMSTERDAM
Mailing Address - State:OH
Mailing Address - Zip Code:43903-7913
Mailing Address - Country:US
Mailing Address - Phone:740-543-4316
Mailing Address - Fax:
Practice Address - Street 1:1102 TOWNSHIP ROAD 267
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:OH
Practice Address - Zip Code:43903-7913
Practice Address - Country:US
Practice Address - Phone:740-543-4316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker