Individual
MRS. TAMMY LEA MAYNARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DI
Contact information
Practice address
1906 GOLDSMITH LN, LOUISVILLE, KY 40218-2066
(502) 498-2927
Mailing address
298 SARATOGA CIR, RICHMOND, KY 40475-8306
(859) 230-8146
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
000069898
KY
Other
Enumeration date
09/20/2010
Last updated
11/01/2018
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