Individual
ALETA CANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
616 S WALLACE WILKINSON BLVD, LIBERTY, KY 42539-3344
(606) 787-6889
Mailing address
1575 LANNOCK DR, DANVILLE, KY 40422-9236
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
R3196
KY
Other
Enumeration date
07/11/2008
Last updated
07/11/2008
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