Provider Demographics
NPI:1356585277
Name:HENRY, PATRICIA ELLEN
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ELLEN
Last Name:HENRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3442 AMBER CT
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-0823
Mailing Address - Country:US
Mailing Address - Phone:270-393-4513
Mailing Address - Fax:
Practice Address - Street 1:3442 AMBER CT
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-0823
Practice Address - Country:US
Practice Address - Phone:270-393-4513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-22
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist