Provider Demographics
NPI:1245547843
Name:ZELIN, KENNETH A (CPED)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:A
Last Name:ZELIN
Suffix:
Gender:M
Credentials:CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16131 LANCASTER HWY STE 3
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-3884
Mailing Address - Country:US
Mailing Address - Phone:704-540-4664
Mailing Address - Fax:704-540-4636
Practice Address - Street 1:16131 LANCASTER HWY STE 3
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-3884
Practice Address - Country:US
Practice Address - Phone:704-540-4664
Practice Address - Fax:704-540-4636
Is Sole Proprietor?:No
Enumeration Date:2010-09-03
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2925225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter