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:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY134170225X00000X, 225XE1200X, 225XH1200X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XE1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistErgonomics