Provider Demographics
NPI:1770744120
Name:BAZZELL, NONA LEE
Entity type:Individual
Prefix:MS
First Name:NONA
Middle Name:LEE
Last Name:BAZZELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4937 SPEAKER TRL
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-5534
Mailing Address - Country:US
Mailing Address - Phone:270-436-2938
Mailing Address - Fax:270-436-2955
Practice Address - Street 1:4937 SPEAKER TRL
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-5534
Practice Address - Country:US
Practice Address - Phone:270-436-2938
Practice Address - Fax:270-436-2955
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X, 222Q00000X
KY1100305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
1770744120OtherNIP