Provider Demographics
NPI:1720337181
Name:KENNEDY, MARCIA ANN (ATC)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:ANN
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O BOX 877
Mailing Address - Street 2:
Mailing Address - City:BOILING SPRING
Mailing Address - State:NC
Mailing Address - Zip Code:28017
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:110 S. MAIN ST
Practice Address - Street 2:
Practice Address - City:BOILING SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:28017
Practice Address - Country:US
Practice Address - Phone:704-406-3583
Practice Address - Fax:704-406-3595
Is Sole Proprietor?:No
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program