Provider Demographics
NPI:1770050429
Name:SECKMAN, KENNEDY LEXUS (AT, ATC)
Entity type:Individual
Prefix:
First Name:KENNEDY
Middle Name:LEXUS
Last Name:SECKMAN
Suffix:
Gender:F
Credentials:AT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3992 COLLEGE HILL RD
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-9726
Mailing Address - Country:US
Mailing Address - Phone:740-825-0140
Mailing Address - Fax:
Practice Address - Street 1:65555 WINTERGREEN RD
Practice Address - Street 2:
Practice Address - City:LORE CITY
Practice Address - State:OH
Practice Address - Zip Code:43755-9715
Practice Address - Country:US
Practice Address - Phone:740-489-5005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-31
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT0057862255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer