Provider Demographics
NPI:1932376175
Name:MAYNES, KENNY D (OTR/L, CHT)
Entity Type:Individual
Prefix:MR
First Name:KENNY
Middle Name:D
Last Name:MAYNES
Suffix:
Gender:M
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 CUMBERLAND FALLS HWY STE C
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-2739
Mailing Address - Country:US
Mailing Address - Phone:606-528-2149
Mailing Address - Fax:
Practice Address - Street 1:1400 CUMBERLAND FALLS HWY STE C
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-2739
Practice Address - Country:US
Practice Address - Phone:606-528-2149
Practice Address - Fax:606-528-2338
Is Sole Proprietor?:No
Enumeration Date:2008-05-15
Last Update Date:2022-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKYR3411225X00000X
KY134170225XH1200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand