Individual
MRS. RENIVA JO S. AVERY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A. EL.ED.
Contact information
Practice address
3770 DEFRIES RD, CANMER, KY 42722
(270) 528-4416
(270) 528-4417
Mailing address
3770 DEFRIES RD, CANMER, KY 42722-9461
(270) 528-4416
(270) 528-4417
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
F254TZ
KY
Other
Enumeration date
11/01/2006
Last updated
03/28/2014
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